Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process encourages early conversations with patients and their loved ones to agree, document and share care and treatment recommendations ahead of serious clinical deterioration. A digital version of the ReSPECT plan was introduced to Leeds Teaching Hospitals Trust (LTHT) in Dec 2018. However, ReSPECT forms are not consistently used to their full potential, and no formal feedback has ever been collected regarding staff views on ReSPECT or the barriers to its completion. This study identifies ways in which the ReSPECT process could be improved for all patients.

Methods Doctors of all grades, across LTHT, received a JISC online survey. The questionnaire contained both quantitative and qualitative aspects, covering nature and frequency of interaction with ReSPECT, barriers to completion, training requirements and examples of good practice. Key themes were identified from free text responses.

Results The study included 111 respondents. It was reported that a higher grade of doctor tends to lead ReSPECT conversations than that who completes the form. Barriers to effective ReSPECT practice included lack of time, prioritisation of acute care, perception that ReSPECT is no broader than Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) recommendations and lack of personal relationship with the patient. Further training would be most valued covering how to handle disagreement and/or uncertainty. Factors which facilitated effective use were proactive whole team involvement with engaged senior leadership and building ResPECT initiation and review into routine processes.

Conclusions Effective use of ReSPECT requires proactive whole-team engagement and systematic inclusion into routine care. EdPucation must focus on the potential of ReSPECT beyond CPR and how to address uncertainty and disagreement. Whilst this study focusses on feedback from only one professional group in one organisation, these findings may be of benefit to other organisations and localities adopting ReSPECT.

NB: Late Submission due to ongoing data analysis at the time of original deadline.