Assessing the quality of ReSPECT documentation using an accountability for reasonableness framework

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Healthcare Documentation

Background:

• The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form aims to improve transparency in emergency treatment decision-making.
• It prompts clinicians to discuss treatment options and document decisions comprehensively.

Purpose of the Study:

• To evaluate the consistency, transparency, and ethical justification of decision-making documented in ReSPECT forms.
• To assess the early adoption of the ReSPECT process in NHS hospitals.

Main Methods:

• Analysis of 141 completed ReSPECT forms (versions 1.0 and 2.0) from six NHS hospitals.
• Utilized a structured evaluation tool based on an accountability for reasonableness framework (AFR).

Main Results:

• Cardiopulmonary resuscitation (CPR) recommendations were consistently recorded but often lacked contextualization.
• Documentation of treatment recommendation details, patient capacity, priorities, and preferences varied significantly.
• Reasons for treatment decisions and the weighing of treatment burdens/benefits were rarely documented.

Conclusions:

• ReSPECT forms capture CPR recommendations but require modifications to improve documentation of patient values, capacity, and clinical reasoning.
• Enhanced training and form design are crucial for patient/family involvement in emergency care planning.
• Version 3.0 of ReSPECT addresses identified areas for improvement.