Article Text

Download PDFPDF

Original research
Secondary care consultant clinicians’ experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis
  1. Karin Eli1,
  2. Cynthia Ochieng2,
  3. Claire Hawkes1,
  4. Gavin D Perkins1,3,
  5. Keith Couper1,3,
  6. Frances Griffiths1,
  7. Anne-Marie Slowther1
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 School of Medicine, Cardiff University, Cardiff, UK
  3. 3 Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Karin Eli; Karin.Eli{at}warwick.ac.uk

Abstract

Objective To examine secondary care consultant clinicians’ experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process.

Design Semi-structured interviews following ward round observations.

Setting Two National Health Service hospitals in England.

Participants Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards.

Analysis Interview transcripts were analysed using thematic analysis.

Results Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient’s short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient’s relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient’s illness trajectory.

Conclusions The management of uncertainty about prognoses and about patients’ emotional reactions is central to secondary care consultant clinicians’ experiences of timing and conducting ReSPECT conversations.

  • emergency care treatment planning
  • advance care planning
  • clinicians’ experiences
  • critical care
  • do not attempt cardiopulmonary resuscitation (DNACPR)
  • decision making
  • qualitative research
  • recommended summary plan for emergency care and treatment (ReSPECT)
  • uncertainty
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • FG and A-MS are joint senior authors.

  • Contributors KE conducted data analysis and drafted the manuscript. A-MS, FG and CH designed the study, supervised the data collection, contributed to data analysis and commented on manuscript drafts. GDP and KC contributed to study design, assisted with accessing the field and commented on manuscript drafts. CO collected the data and commented on manuscript drafts. All authors reviewed and approved the final version of the manuscript.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) under the Health Services and Delivery Research programme (project number 15/15/09). KC is supported by an NIHR postdoctoral research fellowship.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests CH is a member of the ReSPECT national working group and was involved in the evaluation of ReSPECT. GDP is a member of the ReSPECT national working group and held a leading role in the development of ReSPECT; however, GDP was not involved in data collection or analysis related to the present study. A-MS, FG, CH, KC and GDP received grants from the UK National Institute of Health Research during the study.

  • Patient consent for publication Not required.

  • Ethics approval The study received ethics approval from the NRES Committee, West Midlands—Coventry and Warwickshire (REC reference: 17/WM/0134).

  • Provenance and peer review Not commissioned; externally peer reviewed.