The Quality of ResPECT Forms and the Confidence of Resident Doctors

Introduction: ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms should contain personalised recommendations for a person’s future clinical care. Our project assessed the quality of ReSPECT forms and attempted to understand the training resident doctors received and their confidence completing forms. 

Method:  A scoring system out of 9 was created to assess the quality of ResPECT forms. The system assessed factors including legibility, patient and family involvement and mental capacity assessments. It also covered the clarity of documentation around resuscitation, escalation and preferences around future readmissions and preferred place of care and death. We subsequently surveyed resident doctors about the training they received and their confidence completing ReSPECT forms. 

Results: We assessed 50 ReSPECT forms in an elderly care department. 74% received a score of 6 or below and were felt to need improvement. Only 52% of forms documented an escalation status, 42% commented on future hospital admissions, 12% documented a preferred place of care or death. 23% of forms contained vague statements unlikely to help decision-making in an emergency scenario. 28% of forms had legibility issues. 31 resident doctors (between foundation year 1 and registrar level) completed our survey. 84% of respondents had received teaching on ReSPECT forms in the last year, but 71% wanted additional training. 52% did not feel comfortable discussing ReSPECT forms with patients and relatives and 32% did not feel comfortable completing the form. 37% felt simulated or ward-based training on how to discuss the topic and complete a form, would be beneficial. 

Conclusion: There is scope to improve the quality and clarity of the clinical guidance documented on ReSPECT forms. The reported lack of confidence by resident doctors may be a contributory factor. Increased use of ward-based or simulated training may represent a way of improving their confidence and skills.