Evaluating the Integration of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Into Primary Care and Its Impact on Patient Treatment and Care.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 298
- 试验地点
- 1
- 主要终点
- Logistic regression of congruency (Yes/No) between recommendations recorded in the ReSPECT form and actual clinical care.
研究概览
简要总结
When a person becomes seriously ill health professionals treating them need to make decisions quickly. They may have limited information about the person's medical history or about their wishes about treatment. To help health care professionals decide what is the best treatment for that person Emergency Care Treatment Plans can be used. These record what the person would or would not want to happen in certain situations.
The plans are usually written by the person's doctor after discussing it with them. One type of plan, called ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is used in many National Health Service hospitals in the UK. However, it might be better to write these plans when the person is living at home before they are admitted to hospital.
ReSPECT forms are now being used by GPs and other primary care staff in the UK. This project plans to study the ReSPECT process in primary care to determine how, when, and why it is used, and what effect it has on patient treatment and care. It will use a mixture of methods for collecting information. The investigators will interview patients, their families, GPs and care home managers to ask them about their experience of the ReSPECT process.
To get a wider range of views, the investigators will also speak to groups of other health professionals, patient organisations and faith leaders, and carry out national surveys of GPs and the general public. The study will also look how at patient records to see how the ResPECT process makes a difference to decisions about medical treatment when a person is seriously ill. The information from these different methods will be brought together at a stakeholder meeting and will be used to work out how the ReSPECT process can work best to improve patient treatment and care.
详细描述
This is a mixed methods research project comprised of four work packages. The overall theoretical framework within which the study will be analysed is Normalisation Process Theory (NPT). The investigators wish to investigate to what extent ReSPECT is embedded in routine primary care practice and how it is perceived and enacted by health professionals and patients. NPT characterises a set of mechanisms (coherence, cognitive participation, collective action and reflexive monitoring) that influence the embedding of new interventions or processes into clinical practice. The investigators will ask how do clinicians, patients and their families:
- conceptualise ReSPECT (coherence)
- initiate or engage with the process (cognitive participation)
- use the process and the documentation (collective action)
- evaluate it, and how does it change behaviour (reflexive monitoring)
Work package one This will take place in GP practices and care homes across three CCG areas of England where ReSPECT has been implemented. The investigators will recruit 12 GP practices across the three areas and two care homes associated with each practice. In each practice the investigators will interview patients, the carers of patients who lack capacity, GPs and other practice staff. The investigators will ask the practice to identify two care homes for which they are the main practice and seek to interview the care home manager or a senior member of staff.
Patient/carer interviews
The investigators will recruit up to 48 patient/carers across all sites (12 practices) equally from three groups, which are people:
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 115 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Adult (18 years and over) patients with ReSPECT form completed in previous 6 months Carer/next of kin of adult patients without capacity, associated with the ReSPECT form completion General Practitioners involved in ReSPECT process Nursing and care home managers
排除标准
- •Patients in final stages of terminal illness (expected to die within next four weeks) Patients currently in hospital
- •WP2 interviews
- •Inclusion criteria:
- •Faith leaders
- •Exclusion criteria:
- •WP2 surveys
- •Inclusion criteria:
- •Members of the public General Practitioners
- •Exclusion criteria:
- •Inclusion criteria:
- •Adult (18 years and over) patients with a ReSPECT form completed in the previous 12 months
- •Exclusion criteria:
- •Patients who opt-out Patients in final stages of terminal illness (expected to die within next four weeks)
- •Members of patient and carer organisations Community and faith groups Relevant professional organisations Policy makers and regulatory bodies Members of the national ReSPECT working group
结局指标
主要结局
Logistic regression of congruency (Yes/No) between recommendations recorded in the ReSPECT form and actual clinical care.
时间窗: Ongoing data collection between Q3 2021 and Q1 2022
Analysis of congruency (yes/no) between the recommendations recorded on the ReSPECT form and the actual clinical care delivered to patients, as recorded on their medical records, via logistic regression.
Proportion of respondents that would be 'willing' to complete an emergency care treatment plan for themselves (if public survey) and for their patients (if GP survey) compared to those that report that they would be 'unwilling'
时间窗: Single time point cross-sectional survey during Q4 2021
Response to survey questionnaire administered as part of WP2
次要结局
- Logistic regression of congruency (Yes/No) between presence of DNACPR decisions recorded in the ReSPECT form and CPR delivered in actual clinical care, as recorded in the patient's medical record.(Ongoing data collection between Q3 2021 and Q1 2022)
- How willing patients are to complete an emergency care plan on a scale of 0 (unwilling) till 10 (unwilling).(Single time point cross-sectional survey during Q4 2021)
研究者
Professor Anne Slowther
Professor Anne-Marie Slowther
University of Warwick