Award Title: Evaluating the integration of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) into primary care and its impact on patient treatment and care.
Funder: Department of Health and Social Care

Abstract: When a person becomes seriously ill health professionals treating them need to make decisions quickly. They may have limited information about the person’s medical history or about their wishes about treatment. The sick person may not be able to tell them what matters to them. To help health care professionals decide what is the best treatment for that person Emergency Care Treatment Plans can be used. These record what the person would or would not want to happen in certain situations. The plans are usually written by the person’s doctor after discussing it with them. One type of plan, called ReSPECT, is now being used in many NHS hospitals in the UK. However, it might be better to write these plans when the person is living at home rather than after they have been admitted to hospital. ReSPECT forms are now being used by GPs and other primary care staff in the UK. _x000D_
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We want to find out:_x000D_
•	What patients and their families who have been involved in the ReSPECT process think about it?_x000D_
•	What GPs and care home staff think about the ReSPECT process?_x000D_
•	What members of the public think about emergency care treatment plans?_x000D_
•	What other health professionals such as ambulance staff think about the ReSPECT process._x000D_
•	What makes it work well and what stops it working well? _x000D_
•	How does the ReSPECT process makes a difference to decisions about medical treatment when a person is seriously ill?_x000D_
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To answer these questions we will use different methods to gather information about the ReSPECT process in primary care. _x000D_
1.	We will identify 12 GP practices in three different areas across England. In each practice we will speak to people who have a ReSPECT form. If the individual cannot take part, we will speak to a member of their family. We will ask the person or their family about their experience of having the conversation with their doctor. We will also ask them what they think about the process and the form. We will speak to GPs who complete ReSPECT forms to find out their views and to managers of care homes who have residents with a completed ReSPECT form._x000D_
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2.	To get a wider range of views we will:_x000D_
a.	speak to groups of other health professionals_x000D_
b.	speak to members of patient organisations and faith leaders._x000D_
c.	carry out two national surveys, one for GPs and one for the public_x000D_
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3.	We will look at the medical records of people who have a ReSPECT form in our 12 GP practices. We will find out if these people have been seriously unwell since the form was completed. If they have, we will check to see if the decisions made when they were ill matched the recommendations on their ReSPECT form._x000D_
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4.	We will bring together all the information we get from these different methods and use it to work out how the ReSPECT process can work best to improve patient treatment and care._x000D_
We will present our findings at a stakeholder meeting. We will invite patient representatives and health and social care professionals to this meeting. We will ask their views about our research and how we can use it to improve the ReSPECT process._x000D_
We will develop information materials and videos about the ReSPECT process based on our research for patients, their families, and health care professionals. We will distribute these through local, regional and national organisations to make sure our findings help to improve patient’s treatment in emergency situations._x000D_
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Our study lay advisory group will advise us on every stage of the study and help with our analysis.

Lay Abstract: Research questions: _x000D_
1. How, when and why is the ReSPECT process used in primary care?_x000D_
2. What is the impact of the ReSPECT process on patient treatment and care?_x000D_
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Background: Emergency Care Treatment Plans (ECTPs) integrate DNACPR recommendations into overall treatment plans for use in acute or emergency situations when recovery is possible or may be unlikely. They are complementary to, and fit within, the broader concept of advance care planning (ACP). There has been little evaluation of the use of ECTPs to date. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a standardised ECTP developed by a national working group in 2016. It has been adopted in several Clinical Commissioning Groups across England. The recent COVID-19 pandemic has precipitated an increased focus on ECTPs among health care professionals and the public. We propose a mixed-methods evaluation of the ReSPECT process in primary care to determine how, when and why it is used, and what effect it has on patient treatment and care._x000D_
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Our overall aim is to evaluate the use of the ReSPECT process in UK Primary Care and its impact on patient care._x000D_
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Our objectives are to:_x000D_
1.	understand how ReSPECT is currently used in primary care from the perspective of patients, their families, clinicians and care providers_x000D_
2.	describe the views of patients, the public, and primary and community health care professionals on emergency care treatment plans in general and ReSPECT in particular_x000D_
3.	identify enablers and obstacles to embedding ReSPECT in primary care practice_x000D_
4.	explore the impact of ReSPECT on patient treatment decisions_x000D_
5.	develop a consensus on how ReSPECT should be used in primary care_x000D_
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Methods: We propose four work packages_x000D_
WP1: A qualitative study using interviews with GPs, patients and their families/carers, and care home managers of to explore how and why ReSPECT conversations occur and recommendations are made, their ethical basis, and the experiences of patients and their families of the decision-making process. _x000D_
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WP2: Focus groups with health care professionals, and members of patient and community groups to explore their views on the principles and practice of ReSPECT and other forms of anticipatory decision-making. Interviews with faith leaders to explore the extent that the values underpinning the ReSPECT process reflect or are dissonant with specific faith traditions. A national survey of public attitudes to ECTPs and ACP, and a national survey of GPs to explore their experience and views of anticipatory decision-making._x000D_
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WP3: An analysis of congruence of ReSPECT recommendations and subsequent treatment decisions made using an analysis of ReSPECT forms and corresponding patient records._x000D_
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WP4: A synthesis of key findings from the study and a stakeholder meeting drawing on experience based co-design to identify strategies to support integration of the ReSPECT process to primary care practice. _x000D_
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Timeline: months 0-3 study set up; WP1  months 3-18 ; WP2  months 3-15; WP3 months 6-18; WP4 months 18-24._x000D_
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Dissemination and outputs: We will have a dissemination programme for patients and the public, including lay summaries and video resources. Dissemination to practitioners and policy makers will include suggestions for learning resources and frameworks for integrating ECTPs into routine primary care practice.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: GENERIC HEALTH RELEVANCE