ReSPECT Level 3: Conversations
Training for staff who will be initiating or carrying out conversations with patients and their families about treatment escalation, DNACPR, and the ReSPECT process.
ReSPECT Level 3 builds upon the training at Levels 1 and 2, which should be completed first.
Contact firstname.lastname@example.org for access to our implementation workspace with access to:
- Master training slides for all levels of training (PPT)
- Trainers’ handbook with reference information (PDF)
- Guidance for clinical staff editable versions for local adaptation (PPT)
- Training needs analysis (Word)
- Printable blank ReSPECT forms and editable PDF forms
Training resources have been developed based on resources produced by the Resuscitation Council and early implementers. We are very grateful to colleagues in Sussex, NHS Forth Valley, Lincolnshire and Worcestershire who have shared their learning and resources with us.
Having a conversation about ReSPECT
Any healthcare professional who is suitably trained and experienced can complete the form, in close liaison with the patient or their legal advocate.
Identifying patients who may benefit from a ReSPECT conversation
ReSPECT can be for anyone who wants to record their care and treatment preferences, but particularly those who have complex health needs, are likely to be nearing the end of life, or at risk of sudden deterioration or cardiac arrest.
There are some triggers that may prompt healthcare professionals to consider initiating a ReSPECT conversation:
- A new diagnosis of a serious life-limiting condition whether in hospital or primary care.
- People who were otherwise well who have deteriorated suddenly, particularly those over the age of 85 with two or more emergency attendances / admissions in a six month period, identified by Emergency Department or paramedics.
- People over the age of 65 who have been identified as living with moderate or severe frailty, for example through use of the Electronic Frailty Index (eFI) by GPs or SPICT tool.
- People with a chronic condition identified with poor prognostic markers for their condition and therefore may be in the last year of life, for example identified through a poor prognosis letter (PPL) from hospitals to GPs.
Normalising the conversation. Consider asking “Do you have an advanced care plan?” at every admission as part of your clerking process.
The following triggers have been identified by NHS Forth Valley for prioritising emergency/ anticipatory care planning in a hospital setting:
- Life limiting condition
- Care home resident
- Identified risk of acute deterioration, cardiac arrest or death including increasing NEWS2
- All patients with NEWS2>7
- Request by the individual/ family to record preferences
- Long term/ complex health needs
- Recurrent admissions
In a pilot in NHS Forth Valley, 63% of patients in an older adult acute medical ward screened using these triggers were identified as having one or more triggers.
ReSPECT can be used for any age (with appropriate parental involvement for children and young people) however in the first instance in the West of England AHSN region our focus is on adult patients. A ReSPECT compatible Advanced Care Plan is available for Children and Young Persons.
Initiating a discussion about ReSPECT
- Listen to this 14 minute podcast on Having a conversation about ReSPECT with adults produced by the Resuscitation Council.
- Watch this five minute video on Communication Skills from Worcestershire
- Listen to this 50 minute MDTea podcast on advance care planning (and read the show notes).
- Listen to this 50 minute MDTea podcast on communication with relatives (and read the show notes).
- Watch this six minute video on discussing dying produced by NHS Education for Scotland (transcript)
- Read Talking about dying: how to begin honest conversations about what lies ahead produced by the Royal College of Physicians.
ReSPECT can be used for any age (with appropriate parental involvement for children and young people) however in the first instance in the West of England AHSN region our focus is on adult patients. Information on ReSPECT for young people and parents is available on the ReSPECT process website and a 15 minute podcast is available on having a conversation about ReSPECT with children and young persons.
#TalkCPR. Talking about Do Not Attempt CardioPulmonary Resuscitation (DNACPR) is an important part of advance care planning and can help minimise distress at a later stage. NHS Wales have produced a number of very useful videos for healthcare professionals and patients to encourage conversation about CardioPulmonary Resuscitation (CPR) for people affected by life-limiting and palliative illnesses. #TalkCPR tweets
- Read: Decisions relating to cardio-pulmonary resuscitation: Guidance from the British Medical Association, the Resuscitation Council UK) and the Royal College of Nursing. This guidance offers in-depth advice on this topic and the relevant ethical principles involved.
- Read: Recommended language for communicating end-of-life concepts produced by the Australian & New Zealand Intensive Care Society
Completing the form
- Listen to five minute podcast Completing the form produced by the Resuscitation Council.
- Read How to Complete a ReSPECT form: quick guide for clinicians produced by the Resuscitation Council.
- Watch this 14 minute video on the ReSPECT process from Dr Adam Brown, Lincolnshire NHS
- Complete e-learning module: How to check if the ReSPECT form has been filled in correctly. Completing the form (the practical stuff) (10 minutes). Complete all the scenarios and profiles to get a certificate. If you cannot complete all the scenarios in one sitting you have the option to come back to where you left off.
How to check if a ReSPECT form has been filled in correctly
- Review four examples of completed ReSPECT forms produced by Derbyshire Alliance for End of Life Care.
- An example audit process is available on our workspace. Email email@example.com for access.
Communicating the form
Once a ReSPECT form is completed by a senior clinician (doctor or nurse), and has been countersigned (if appropriate), it is their responsibility to inform the wider health team.
Once a form is completed, it is important that the person keeps it with them, and that it is readily available for professionals who may need to see and use it.
Templates are available for EMIS and SystemOne as well as printable and editable PDF versions. Email firstname.lastname@example.org for access.
ReSPECT is a paper patient held record. This is also the case for the existing DNACPR form. The national ReSPECT Working Group is committed to the development of a digitised version of ReSPECT. It should be noted that no time frame has yet been set for this and therefore areas across the country have not delayed their adoption of ReSPECT on this basis.
For more information on the digital implementation of ReSPECT in the West of England read our output report from our 20 March 2019 event.
The ReSPECT form, legal status and relationship with other areas