Eli Karin, Bernstein Celia J, Harlock Jenny, Huxley Caroline J, Walsh Julia, Blanchard Hazel, Hawkes Claire A, Perkins Gavin D, Turner Chris, Griffiths Frances, Slowther Anne-Marie
Warwick Medical School, University of Warwick, Coventry, UK
Warwick Medical School, University of Warwick, Coventry, UK.
J Med Ethics. 2025 Jul 23;51(8):526-532. doi: 10.1136/jme-2024-110144.
In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby enable the attending clinician-usually a general practitioner (GP) or paramedic-to act in the patient's best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient's best interests. We suggest that recording patients' values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations.
在英国，《紧急护理与治疗推荐总结计划》（ReSPECT）是一个广泛使用的流程，旨在促进临床医生与患者之间的共同决策，或者，如果患者缺乏参与对话的能力，则促进临床医生与患者身边亲近的人之间的共同决策。ReSPECT流程的一个关键成果是一组记录在患者持有的ReSPECT表格上的建议，这些建议反映了对话内容。在紧急情况下，这些建议旨在为临床决策提供依据，从而使主治临床医生（通常是全科医生或护理人员）能够按照患者的最大利益行事。本研究首次探讨了ReSPECT建议在多大程度上实现了其在社区环境中为符合患者最大利益的决策提供依据的目标。我们采用改良的框架分析方法，将对患者及其亲属、全科医生、护士和养老院工作人员的访谈进行三角互证。我们的研究结果表明，在记录患者意愿方面做法不一致、对建议的含义和权威性有不同解读以及不同的情境背景可能会影响对ReSPECT建议的解读和实施。在紧急情况下实施ReSPECT建议可能充满复杂性，尤其是当主治临床医生需要解读未预料到当前紧急情况的建议时。这可能导致决策损害患者的最大利益。我们建议在ReSPECT表格上更详细地记录患者的价值观和偏好，这可能有助于克服这一挑战，为主治临床医生提供更丰富的背景信息，以便他们解读治疗建议。
