Primary Supervisor: Dr Zoe Fritz, zbmf2@cam.ac.uk
Project Outline
The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process was developed in response to problems with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) ‘orders’. (Fritz et al , 2013 and Hawkes et al 2020). There was evidence that they were often not discussed, and that they could be misunderstood to mean that other, potentially beneficial treatments, should not be given. (Perkins et al 2016). The ReSPECT process guides a patient and a clinician to establish a shared understanding about the patient’s condition and prognosis; the patient’s values and fears; and what treatments would be most likely to get them to their valued outcomes while avoiding unwanted treatments or interventions. ReSPECT can be for anybody, but is particular importance for those approaching the end of life, those with complex health conditions, and those who have strong views about health outcomes (Fritz et al 2017). This means that many older patients have ReSPECT conversations and plans, and it is vital to understand older patients’ needs with regards to ReSPECT.
Recent studies of the use of ReSPECT suggest that, while it was deigned to cross care settings, there are issues with the documentation, interpretation and interoperability. (Slowther et al 2025). For example, some recommendations that are made in hospital (eg “for ward-based treatments” to advise that admission to an intensive care unit would not be desired) can be misunderstood in the community (interpreted that the patient should be conveyed to hospital in all circumstances).
This project will establish how to respect patient goals across care settings, examining current practice, patient and clinician experience, and digital interoperability. It will consider the ethical and logistical issues associated with current practice, and how to address these.
It will start with a retrospective analysis of documentation of ReSPECT plans of patients over the age of 80 who have been admitted to hospital and discharged into the community at least once in the last year, to evaluate how these plans are documented, reviewed and altered.
Qualitative interviews with key stakeholders (patients, carers, hospital doctors, care home managers, general practitioners, community geriatricians, specialist nurses, and others) will be undertaken to establish perceptions of current practice, and how it could be improved.
A review of the digital infrastructure supporting respect (including access and editing) in one region will be undertaken to establish areas of strength and areas which could be improved.
The evidence gathered will be synthesised and disseminated locally, nationally, and to Resuscitation Council UK in order to help shape recommendations to improve practice.
Project Plan
Year 1: Familiarisation with literature, protocol writing, ethics approvals, network established with clinicians, patient groups and digital providers.
Year 2: Retrospective analysis of ReSPECT plan documentation and use and infrastructure review
Year 3: infrastructure review and qualitative interviews
Year 4: Ethical analysis, write up, recommendations and dissemination
Main Methods to be Used
Empirical ethics (Huxtable and Ives 2019) overarching methodology including:
Retrospective note analysis
Quantitative analysis
Qualitative Analysis
Ethical analysis
Key References
Fritz Z, et al Resuscitation policy should focus on the patient, not the decision BMJ 2017; 356 :j813 doi:10.1136/bmj.j813
Fritz Z, et al The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care. PLoS One. 2013 Sep 4;8(9):e70977. doi: 10.1371/journal.pone.0070977. PMID: 24023718; PMCID: PMC3762818.
Hawkes CA et al ; ReSPECT working group collaborators. Development of the Recommended Summary Plan for eEmergency Care and Treatment (ReSPECT). Resuscitation. 2020 Mar 1;148:98-107. doi: 10.1016/j.resuscitation.2020.01.003. Epub 2020 Jan 13. PMID: 31945422.
Huxtable R, Ives J. Mapping, framing, shaping: a framework for empirical bioethics research projects. BMC Medical Ethics. 2019 Nov 27;20(1):86.
Perkins GD, et al. Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis. Southampton (UK): NIHR Journals Library; 2016 Apr. (Health Services and Delivery Research, No. 4.11.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK355498/ doi: 10.3310/hsdr04110
Slowther AM et al Experiences of using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in English general practice: a qualitative study among key primary health and social care professionals, patients, and their relatives British Journal of General Practice 2025; 75 (751): e143-e152. DOI: 10.3399/BJGP.2024.0248