Improving the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process: Insights from qualitative interviews

Introduction.

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning tool used to ensure that patients receive care in line with their preferences and medical needs (Resuscitation Council UK, 2025). Over 2024/2025 DNACPR (Do-Not-Attempt Cardiopulmonary Resuscitation) forms were replaced with ReSPECT at Nottingham University Hospitals (NUH). ReSPECT is now the sole documentation method for resuscitation decisions at NUH in adults. This is a significant change, so this qualitative study aimed to identify what worked well and what could be improved.

Methods

Interviews with staff were audio-recorded, transcribed and anonymised. Thematic analysis was used.

Results

Twenty-three staff were interviewed from different medical specialties and roles. Analysis identified ten themes:

1.      Value. 

2.      Facilitators of good practice.

3.      Barriers to good practice.

4.      Clinical recommendations for emergency care and treatment section.

5.      Primary–secondary care interface.

6.      Systems and process.

7.      Training and education.

8.      Gold standard.

9.      Misconceptions.

10.     Suggestions for improvement.

Conclusion.

Overall, ReSPECT is welcomed. It is felt it can add value to patient care, workload and finances. However, issues exist. The study has raised the question is there still a role for a standalone DNACPR decision, or whether the ReSPECT process can, and should, be tailored to different scenarios. Moving to a digital form was identified as the most important change. This study highlights a need for ReSPECT to move from a reactive to a proactive process. The clinical value of ReSPECT directly relates to the quality of the conversation and documentation and the quality needs to improve. Clearer processes, digital forms, normalising conversations about dying, proactive identification of patients in the community, education and protected time would help achieve this. These ideas align with the National Health Service Long-Term Plan—analogue to digital, hospital to community and sickness to prevention (GOV.UK,2025). 

References:

GOV.UK (2025) Build an NHS Fit For the Future [online]. GOV.UK: London, 2025. Available at: Build an NHS Fit For the Future - GOV.UK. [accessed 12th May 2026]. 

Resuscitation Council UK (2025) ReSPECT for patients and carers [online]. The Resuscitation Council UK: London; 2025. Available at: ReSPECT for patients and carers | Resuscitation Council UK. [accessed 12th May 2026]