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.

Research questions: 1. How, when and why is the ReSPECT process used in primary care? 2. What is the impact of the ReSPECT process on patient treatment and care?

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. Our overall aim is to evaluate the use of the ReSPECT process in UK Primary Care and its impact on patient care. Our objectives are to:

1. understand how ReSPECT is currently used in primary care from the perspective of patients, their families, clinicians and care providers

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 3. identify enablers and obstacles to embedding ReSPECT in primary care practice 4. explore the impact of ReSPECT on patient treatment decisions

5. develop a consensus on how ReSPECT should be used in primary care Methods: We propose four work packages

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.

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.

WP3: An analysis of congruence of ReSPECT recommendations and subsequent treatment decisions made using an analysis of ReSPECT forms and corresponding patient records.

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. Timeline: months 0-3 study set up; WP1 months 3-18 ; WP2 months 3-15; WP3 months 6-18; WP4 months 18-24.

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.