Making Every Conversation Count: Increasing the Frequency of ReSPECT Conversations Within Dundee Frailty at Home Team (DF@H)

Introduction/Background 

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a national approach documenting recommendations for future and emergency care, including DNACPR. It promotes shared decision-making and personalised care and treatment, particularly relevant with an ageing global population.  The Dundee Frailty at Home Team (DF@H) comprises Geriatricians, Advanced Nurse Practitioners, nurses and allied health professionals, providing community-based assessment and management of frail patients equivalent to inpatient care.  

Aims  

The project aimed to increase quality ReSPECT conversations and incidences of published forms among DF@H patients with a Clinical Frailty Score >7 or concurrent dementia. 

Methods  

Data from patients discharged between July 2025–July 2026 was evaluated; examining demographics, ReSPECT discussions and publication, DNACPR status and dementia diagnosis. An educational intervention on ReSPECT was delivered between data collection periods (December 2025–February 2026 and July 2026). 

Results  

Pre-intervention 

Data from 262 discharges over 3 months was analysed. The mean age was 84, with a 1:1.8 male-to-female ratio. ReSPECT discussions occurred in 34.4%, with 17.8% having a published form at discharge.   

Post-Intervention 

Data from 94 patients discharged over 1 month was analysed. The average age was 86, with a 1:1.8 male-to-female ratio. ReSPECT discussions occurred in 23.4% (10.9% decrease between cycles), with 10.6% having a published ReSPECT form at discharge (6.5% decrease between cycles).  

Following intervention, ReSPECT publication against CFS increased significantly by 200% for CFS 7 patients (20% vs 60%) but decreased by 12% for CFS 8 patients (75% vs 66%). Among patients with dementia, publication increased by 152% (22% vs 55.5%).   

Conclusion  

As mortality increases with each CFS point, timely ReSPECT discussions prior to deterioration or terminal events is key, particularly for patients with dementia. ReSPECT conversations support treatment and care aligned with a patients’ wishes and best interests, exemplifying Realistic Medicine in practice.