A Qualitative Audit of ReSPECT Form Discussions in Dementia Inpatient Units

Introduction:
What is the most significant conversation you’ve ever had?
A question for which everyone reading will have their own answer. You may vividly recall what was said, where, by whom, and in what manner. In a healthcare setting, a clinician must always consider the ways in which our daily work can involve conversations as salient as this for our patients, their families and carers. Discussing ceiling of care is one such instance. With ReSPECT now reflected in HPFT policy as standard practice, this audit explores how patients and carers experience these discussions.
ReSPECT forms facilitate personalised care recommendations for patients who may deteriorate. In dementia care, these conversations often involve family or carers due to fluctuating capacity.

This audit aimed to explore family and carer perspectives on ReSPECT form discussions, focusing on timing, clarity, emotional impact and participation.

Methodology:
We provided qualitative feedback forms post-discussion for thematic analysis of free-text responses to 18 questions, and obtained 4 completed forms.

Key findings:
Timing: All respondents felt the discussion was held at the right time.
Clarity: Most found the information clear, but some wanted pre-discussion leaflets so they can come more prepared, or consider things as a family before the discussion.
Participation: Families valued existing practices around inclusion in the process. They were not always aware of the option to sign the ReSPECT form.
Preparation: Lack of advance notice was raised as an area for improvement.

Conclusion:
Timing of ReSPECT discussions is variable, often dependent on immediate clinical context. Families desire preparatory materials (leaflets, pre-discussion calls). Emotional sensitivity is valued and should remain a clinical priority. Clarity of interventions was generally good in this audit, but demystifying medical terminology remains essential.