Policy briefing

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

How nurses can implement changes to the RCUK process for end of life decision-making

How nurses can implement changes to Resuscitation Council UKs process for end of life decision-making

Picture: iStock

Essential information

As patients in emergency situations are often unable to make decisions about their priorities for care or treatment choices, advance discussions are essential.

The pandemic has further highlighted the importance of sensitive and well-structured conversations about a persons realistic care choices, with a need for shared understanding between patients, their families and healthcare professionals, says the Resuscitation Council UK (RCUK).

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 regarding possible emergency treatment, including whether

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How nurses can implement changes to Resuscitation Council UK’s process for end of life decision-making

A nurses discussing advance care planning with an older patient
Picture: iStock

Essential information

As patients in emergency situations are often unable to make decisions about their priorities for care or treatment choices, advance discussions are essential.

The pandemic has further highlighted the importance of sensitive and well-structured conversations about a person’s realistic care choices, with a need for shared understanding between patients, their families and healthcare professionals, says the Resuscitation Council UK (RCUK).

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 regarding possible emergency treatment, including whether cardiopulmonary resuscitation (CPR) should be attempted. The process is intended to respect both patient preferences and clinical judgement.

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 have resulted in a more patient-centred form, with increased prompts for explicit clinical reasoning, says RCUK. They 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, rather than simply a choice between prioritising sustaining life and prioritising comfort.
  • 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 of their condition; the outcomes the patient values and those they fear; and how realistic treatments and interventions, such as CPR, might 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.

Close-up of a person's hands as they complete a written form, while another person sits opposite them.
Picture: iStock

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 – for example, from hospital to a nursing home.

Expert comment

Carolyn Doyle, 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, both in the document’s ethos and language. 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, reduces the possibility of misunderstandings, and makes for better informed decisions. It will help ensure the wishes of all those involved are properly understood and acknowledged, embracing the ethos of “what matters 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.’

Lynne Pearce is a health journalist


Find out more

ReSPECT for healthcare professionals (RCUK)

ReSPECT form version 3 (RCUK)

RCUK COVID-19 resources related to decision-making

ReSPECT learning app

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