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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
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Official URL: https://doi.org/10.1016/j.resplu.2022.100255
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 | |||||||||
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| 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: |
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| 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 | |||||||||
| RIOXX Funder/Project Grant: |
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