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ReSPECT form update: a more patient-centred focus for advance care planning

Lynne Pearce Health journalist

Essential information

Advance discussions are essential because people in emergency situations cannot always make decisions about their priorities for care or treatment choices.

Nursing Management. 27, 6, 10-10. doi: 10.7748/nm.27.6.10.s9

Published: 26 November 2020

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The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process, introduced by the RCUK in 2016, is widely used by health and social care organisations in England and parts of Scotland. It supports these vital conversations with patients on possible emergency treatment, including whether cardiopulmonary resuscitation (CPR) should be attempted.

Picture credit: iStock

What’s new?

In September 2020, RCUK updated the process, publishing a third version of ReSPECT. This followed feedback from organisations that have adopted the ReSPECT process, as well as clinicians, patients and members of the public.

The changes address areas where misunderstandings have been reported and include more personable and clearer language.

Particular changes include:

» The ability to record a clinical recommendation to balance extending life with comfort and valued outcomes,. » A prompt to ensure that when decisions are made without involving the patient, the reasons for this are clearly recorded.
» A reminder that if a person lacks capacity, a ReSPECT conversation must take place with the family or legal proxy.
» The overall aim remains the same: to develop a shared understanding between the healthcare professional and the patient; the outcomes the patient values and those they fear; and how realistic treatments and interventions, such as CPR, fit into this.

Completed forms remain with the patient and should be made available immediately to health professionals responding in an emergency, whether the patient is at home, or in a community or healthcare setting.

Expert comment

Carolyn Doyle is RCN professional lead for community and end of life care nursing:

‘This is welcome updated guidance. Central to this new version is the consistent person-centred approach.

It makes it much easier for the person and their loved ones, to be involved in discussions about their emergency care and treatment plans.

‘The personable use of language supports easier discussions, and reduces the possibility of misunderstandings. It will help ensure the wishes of all those involved are properly understood and acknowledged, embracing the ethos of “what maêrs to me” as people approach their end of life. It also reflects recent changes in legislation regarding organ donation, advocating the collection of decisions regarding donation to be maintained centrally, via the NHS Organ Donor Register. This reduces duplication and the potential for miscommunication.’

Key points for nurses

» If your organisation already uses the ReSPECT process, make sure you understand it fully
» The RCUK has developed learning resources about the process, which cover who it is for; how to have a ReSPECT conversation; the practicalities of the process; and how to care for someone who has a completed form
» Conversations and the form should be documented in a patient’s records, with an alert showing the existence of the form. Entries should be legible and unambiguous, with wording appropriate for community, ambulance and acute hospital staff to read, understand and be guided by.
» Entries should be reviewed when a person’s condition changes or they move from one setting to another, such as from hospital to a nursing home