Enhancing Advance Care Planning Documentation and Conversations Using ReSPECT Forms: A Quality Improvement Project

Background 

This project at St James’s University Hospital involves resident doctors, advanced care practitioners, and patients on Elderly Care Wards where advance care planning (ACP) is commonly needed. 

Introduction 

ACP helps patients express future care preferences but can be challenging to initiate and document. The ReSPECT form standardises the recording of patient wishes, and the Clinical Frailty Score (CFS) predicts mortality risk, particularly if ≥5. 

This project aims to improve ACP discussions and documentation for patients with CFS ≥5 and to boost doctors’ confidence in leading these conversations. 

Methods 

The PDSA framework is being used to implement and evaluate changes. 

Baseline data were collected retrospectively from patients discharged or deceased over one week in February 2025. Data included CFS, ReSPECT form, ACP documentation, and SPICT indicators (a tool to identify those who may benefit from ACP). An initial survey of resident doctors assessed confidence, educational needs, and barriers. 

A training session shared audit results, emphasised the importance of ACP, reviewed cases, and provided communication tips. Follow-up data and feedback were collected one week later to inform next steps. 

Results 

Baseline data showed 42% of patients with CFS ≥5 had new or updated ReSPECT forms during admission. After the training session, repeat data collection revealed 33.7% had new/updated forms. All forms documented resuscitation and escalation decisions, but other ACP aspects were rarely addressed, both before and after training. 

100% of participants reported increased confidence in understanding and facilitating ACP. 

Conclusion 

Training improved confidence levels but this did not translate into improved documentation. To enhance impact, the session will be included in other teaching programmes. Two further PDSA cycles are planned: an educational poster, and integration of ACP discussions into ward MDT meetings. 

Future development aims to involve patients and families to further improve ACP and patient care.