The ReSPECT form has free-text fields that record patients` priorities for care and treatment, as well as the clinical recommendations of the physician completing the form. In NBSG, completed primary care forms are completed on an electronic health record template. This template suggests drop-down options for both of these items. These are presented in Table 2. The last drop-down option for “clinical recommendations” is an option to enter free text. Due to information governance considerations and data limitations, we can only see if this box has been checked, but not the free text entered. This is a limitation that is examined in our study, as we can analyze how many forms used the suggested options and how many used free text. ReSPECT was developed after participants at a Royal Society of Medicine summit on cardiopulmonary resuscitation decisions (DNACPR) in the UK criticized the variability and problematic practices associated with stand-alone DNACPR decisions.  In particular, decisions related to the DNACPR have not been systematically considered, have often been poorly discussed or not discussed at all, and have misunderstood that other treatments should be refused.
    Other approaches have been developed internationally, including medical prescriptions for life-sustaining treatment (POLTS) for people at the end of life. One of these approaches, which contextualizes CPR decision within overall goals of care, the Universal Form of Treatment Options (ULT), has addressed many of the problems associated with autonomous NSCLC decisions.   These data were presented to the UK Government`s Health Select Committee, which recommended that “the Government review the use of DNACPR prescriptions in acute care settings, including whether resuscitation decisions should be considered in the context of general treatment plans” and suggested standardising record-keeping mechanisms for the NHS in England.  The Ministry of Health has responded positively to this recommendation to improve processes focused on patient goals. In 2015, she documented that a working group had been set up “to develop a national formulary that records decisions about CPR and other life-sustaining treatments as part of a larger plan.”  The development of the ReSPECT process included a literature review, a national consultation, interviews with health professionals and the public, a workshop with patients and the public, and a usability study.  In light of these conflicting findings, the existing literature recommends further work to adequately train clinicians in the ReSPECT process, particularly with respect to the breadth of desired goals and better involvement of patients and families in decision-making and documentation. This influenced the development of V.3 of the ReSPECT form (2020).14 Other recommendations include that future studies specifically investigate the interaction of the ReSPECT form between primary and secondary care, which will be considered in this study.13 Two unknowns contribute to the rationale for this study. Initially, 4 months before the start of the pandemic, the implementation of the ReSPECT process in the BNSSG area began. During this period, it can be assumed that clinicians are still accustomed to the new process. With the onset of the pandemic, it is also likely that clinicians` use of the ReSPECT form has changed due to experience gained and necessity. We will examine which patients received a ReSPECT form in the first year of implementation and which models changed during the year.
We will also examine the fairness of patients who had a documented ReSPECT form, such as the proportion of those diagnosed with cancer or those living in a nursing home or similar community residence. In addition, the impact of the ReSPECT process on patient outcomes in emergency and end-of-life situations during the pandemic has not yet been studied. Therefore, by reviewing the implementation of the ReSPECT form and its results, we hope to inform the future use of the ReSPECT form in the BNSSG space, future implementation processes across the UK and contribute to the evidence base for further impact on patient outcomes. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. This is an Emergency Care and Treatment Plan (ECTP) used in parts of the UK that produces personalised recommendations for future clinical care and emergency treatment through discussions between healthcare professionals and a person (or their legal representative or relatives).  These recommendations are then documented on a ReSPECT form.  Socio-demographic, medical and respect data to be collected Patient and public involvement: Patients and/or the public were involved in the design, conduct, reporting or dissemination of this research. For more information, see Methods. The data are analyzed using the statistical programs “R” and “Stata”. Logistic regression models (adjusted for age, sex and Charlson`s comorbidity index) are used to compare the above patient care outcomes between those who received a ReSPECT form in the community, hospital and those who did not have a ReSPECT form. We will conduct an observational cross-sectional study in patients with ReGEZ forms. This will provide the number of completed ReSPECT forms within the study population, as well as patient demographics, medical conditions, and ReSPECT form details.
The data are analyzed using the statistical programs “R” and “Stata”. For individuals who completed a ReSPECT form during the first wave of COVID-19, summary statistics are used to describe socio-demographic variables, medical variables, and ReSPECT form elements (as shown in Table 1). These variables are described at different times around the first wave of COVID-19 in the UK (as described in the primary outcome of this phase). Categorical variables are aggregated using percentages over the three periods, with differences between these periods analysed using χ2 tests. For continuous variables, we use means and SD to summarize and analyze tests of variance (or Kruskal-Wallis tests for anomalous data) for differences between periods. If you are a healthcare organization looking to implement ReSPECT in your area, please contact firstname.lastname@example.org The ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process was developed by a national working group of healthcare professional organisations, regulators and patient advocates working with the Resuscitation Council UK.1 It is designed as a standardized solution for Forward Planning Practices (PCA) and do not attempt to document cardiopulmonary resuscitation (CPRL) and implementation has already taken place in various parts of the UK. The ReSPECT process involves discussions between patients, their caregivers, and physicians, and results in a clinician-completed ReSPECT form that records patients` treatment preferences, beyond simply documenting cardiopulmonary resuscitation (CPR) decisions. All data collected is pseudonymized. In addition to the number of ReSPECT forms completed, we also collect data on certain variables.
These variables were identified in consultation with the Student Advisory Group (comprised of stakeholders from local commissioning agencies, clinics and academics). Sociodemographic variables were specifically selected to describe our population within our dataset constraints. One of these limitations is “ethnicity,” which is poorly documented in local electronic health records. Medical condition variables were selected based on their perceived relevance to clinicians in identifying patients who would benefit from the ReGEZ process. The variables “ReSPECT and End of Life” were also selected within the limits of our data to specifically meet our objectives of reviewing the ReSPECT Prioritization, Recommendations and Results Models.