Secondary care consultant clinicians' experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis.

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ID: 87535
2020
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Abstract
To examine secondary care consultant clinicians' experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process.Semi-structured interviews following ward round observations.Two National Health Service hospitals in England.Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards.Interview transcripts were analysed using thematic analysis.Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient's short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient's relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient's illness trajectory.The management of uncertainty about prognoses and about patients' emotional reactions is central to secondary care consultant clinicians' experiences of timing and conducting ReSPECT conversations.
Reference Key
eli2020secondarybmj Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Eli, Karin;Ochieng, Cynthia;Hawkes, Claire;Perkins, Gavin D;Couper, Keith;Griffiths, Frances;Slowther, Anne-Marie;
Journal BMJ open
Year 2020
DOI
10.1136/bmjopen-2019-031633
URL
Keywords
uncertainty decision making qualitative research critical care advance care planning clinicians’ experiences do not attempt cardiopulmonary resuscitation (dnacpr) emergency care treatment planning recommended summary plan for emergency care and treatment (respect)

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