Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in UK general practice: a qualitative exploration of the experiences of general practitioners, community-based nurses, care home staff, patients and their relatives.

Background The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) has been implemented in many areas of the UK. It is unclear how ReSPECT is used in primary and community care settings. Aim To investigate how the ReSPECT process is understood and experienced in the community by clinicians, social care staff, patients, their relatives, and identify obstacles and enablers to its implementation. Design and setting. A qualitative interview and focus group study across 13 general practices in three areas in England. Method We interviewed GPs, specialist nurses, patients and relatives, and senior care home staff. Focus groups were conducted with community-nurses, paramedics, and home-care workers. Questions focused on understanding experiences of and engagements with ReSPECT. We analysed data using thematic analysis and a coding framework drawn from Normalisation Process Theory. Results Participants included 21 GPs, five specialist nurses, nine patients, seven relatives, 31 care home staff, nine community nurses, seven home-care workers and two paramedics. Participants supported ReSPECT regarding it as a tool to facilitate person-centred care. GPs faced challenges in timing introduction of ReSPECT and ensuring sufficient time to complete plans with patients. ReSPECT conversations worked best when there was a trusting relationship between clinician and patient (and their family). Anticipating future illness trajectories was difficult yet plans were rarely reviewed. Interpreting recommendations in emergencies was challenging. Conclusion The ReSPECT process has not translated as well as expected in the community setting. A revised approach is needed to address the challenges of implementation in this context.