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Why are some ReSPECT conversations left incomplete? A qualitative case study analysis

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Eli, Karin, Huxley, Caroline J., Hawkes, Claire, Perkins, Gavin D., Slowther, Anne-Marie and Griffiths, Frances (2022) Why are some ReSPECT conversations left incomplete? A qualitative case study analysis. Resuscitation Plus, 10 . 100255. doi:10.1016/j.resplu.2022.100255 ISSN 2666-5204.

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Official URL: https://doi.org/10.1016/j.resplu.2022.100255

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Abstract

Background
As an emergency care and treatment planning process (ECTP), a key feature of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is the engagement of patients and/or their representatives in conversations about treatment options including, but not limited to, cardiopulmonary resuscitation (CPR). However, qualitative research suggests that some ReSPECT conversations lead to partial or no decision-making about treatment recommendations. This paper explores why some ReSPECT conversations are left incomplete.

Methods
Drawing on observation and interview data collected in four National Health Service (NHS) hospital sites in England, this paper offers an in-depth exploration of six case studies in which ReSPECT conversations were incomplete. Using thematic analysis, we triangulate fieldnote data documenting these conversations with interview data in which the doctors who conducted these conversations shared their perceptions and reflected on their decision-making processes.

Results
We identified two themes, both focused on ‘mismatch’: (1) Mismatch between the doctor’s clinical priorities and the patient’s/family’s immediate needs; and (2) mismatch between the doctor’s conversation scripts, which included patient autonomy, the feasibility of CPR, and what medicine can and should do to prolong a patient’s life, and the patient’s/family’s understandings of these concepts.

Conclusions
This case study analysis of six ReSPECT conversations found that mismatch between doctors’ priorities and understandings and those of patients and/or their relatives led to incomplete ReSPECT conversations. Future research should explore methods to overcome these mismatches.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Emergency medicine -- Great Britain, Medical emergencies -- Great Britain, Physician and patient -- Great Britain, Communication in medicine -- Great Britain
Journal or Publication Title: Resuscitation Plus
Publisher: Elsevier
ISSN: 2666-5204
Official Date: June 2022
Dates:
DateEvent
June 2022Published
14 June 2022Available
20 May 2022Accepted
Volume: 10
Article Number: 100255
DOI: 10.1016/j.resplu.2022.100255
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 24 May 2022
Date of first compliant Open Access: 28 June 2022
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
15/15/09[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
Applied Research Collaboration (ARC) West Midlands[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
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