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Secondary care consultant clinicians’ experiences of conducting emergency care and treatment planning conversations in England : an interview-based analysis
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Eli, Karin, Ochieng, Cynthia, Hawkes, Claire, Perkins, Gavin D., Couper, Keith, Griffiths, Frances and Slowther, Anne-Marie (2019) Secondary care consultant clinicians’ experiences of conducting emergency care and treatment planning conversations in England : an interview-based analysis. BMJ Open, 10 . e031633. doi:10.1136/bmjopen-2019-031633 ISSN 2044-6055.
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Official URL: https://doi.org/10.1136/bmjopen-2019-031633
Abstract
Objective To examine secondary care consultant clinicians’ experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process.
Design Semi-structured interviews following ward round observations.
Setting Two National Health Service hospitals in England.
Participants Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards.
Analysis Interview transcripts were analysed using thematic analysis.
Results Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient’s short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient’s relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient’s illness trajectory.
Conclusions The management of uncertainty about prognoses and about patients’ emotional reactions is central to secondary care consultant clinicians’ experiences of timing and conducting ReSPECT conversations.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| Library of Congress Subject Headings (LCSH): | Health planning -- England, Critical care medicine -- Decision making, Emergency medicine -- Decision making, Advance directives (Medical care) -- England, Medical consultants -- Interviews | ||||||
| Journal or Publication Title: | BMJ Open | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 2044-6055 | ||||||
| Official Date: | 20 January 2019 | ||||||
| Dates: |
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| Volume: | 10 | ||||||
| Article Number: | e031633 | ||||||
| DOI: | 10.1136/bmjopen-2019-031633 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 9 October 2019 | ||||||
| Date of first compliant Open Access: | 9 October 2019 | ||||||
| RIOXX Funder/Project Grant: |
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