Experiences of using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in English general practice: a qualitative study among key primary health and social care professionals, patients, and their relatives.

Abstract

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) has been implemented in many areas of the UK. It is unclear how ReSPECT is used in primary and community care settings. To investigate how the ReSPECT process is understood and experienced in the community by clinicians, social care staff, patients, their relatives, and identify obstacles and enablers to its implementation. A qualitative interview and focus-group study across 13 general practices in three areas of England, between January and December 2022. We interviewed GPs, specialist nurses, patients and relatives, and senior care home staff. Focus groups were conducted with community nurses, paramedics, and home care workers. Questions focused on understanding experiences of, and engagement with, ReSPECT. We analysed data using thematic analysis and a coding framework drawn from normalisation process theory. Participants included <i>n</i> = 21 GPs, <i>n</i> = 5 specialist nurses, <i>n</i> = 9 patients, <i>n</i> = 7 relatives, <i>n</i> = 31 care home staff, <i>n</i> = 9 community nurses, <i>n</i> = 7 home care workers, and <i>n</i> = 2 paramedics. Participants supported ReSPECT, regarding it as a tool to facilitate person-centred care. GPs faced challenges in timing the introduction of ReSPECT and ensuring sufficient time to complete plans with patients. ReSPECT conversations worked best when there was a trusting relationship between the clinician and the patient (and their family). Anticipating future illness trajectories was difficult, yet plans were rarely reviewed. Interpreting recommendations in emergencies was challenging. The ReSPECT process has not translated as well as expected in the community setting. A revised approach is needed to address the challenges of implementation in this context.