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ReSPECT and ReSPECT Plus

Information for patients and families in Bristol, North Somerset and South Gloucestershire

What is ReSPECT?

The ReSPECT process creates personalised recommendations for your care in emergency situations where you are not able to make decisions or express your wishes. ReSPECT is a process endorsed by the National Resuscitation Council UK.

Who is it for?

The ReSPECT process can be for anyone but will have increasing relevance for people who have complex health needs, people who are likely to be nearing the end of their lives, or people who are at risk of sudden deterioration or cardiac arrest. Some people will want to record their care and treatment preferences for other reasons.

How does it work?

The plan is created through conversations between health care professionals and you. The aim of the process is to provide a summary of personalised recommendations to ensure that, in an emergency, you will receive the best possible treatment for your individual situation. After discussions with you, the health care professional will complete a ReSPECT form and give this to you. It is important that you keep the ReSPECT form with you and try to make sure that it will be available to health care professionals in an emergency. If you are at home you should store all the pages together, somewhere easily accessible such as at the front of the Community Teams folder (if you have one) and tell family and carers where it is.

What does it cover?

The form guides clinicians who have to make rapid decisions for you in an emergency, so that they can choose the right balance between focusing treatment mainly on prolonging life and providing comfort. The form covers information about your illness, what is important to you and details of people to be contacted in an emergency. It includes clinical recommendations about specific treatments that you would want to be considered or that you would not want, or those that would not work in your situation or could cause you harm.

Cardiopulmonary resuscitation (CPR)

The ReSPECT form includes a section about whether cardiopulmonary resuscitation (CPR) is recommended if your heart and breathing were to stop. Discussions about CPR are difficult and you may want to have someone with you for support.

CPR is often unsuccessful, particularly in people who have serious underlying health problems. If there is a chance that CPR might be successful, your views on CPR, and the risk of long-term complications from attempting CPR, are all very important in deciding whether CPR is the right choice for you. Health care professionals will make a shared decision with you and will record this on the form.

If CPR will not be successful in restarting your heart and breathing, the health care professional will record that CPR attempts are not recommended on the ReSPECT form.

They will explain to you the decision and the reasons for it, unless they believe that telling you will cause you physical or psychological harm. In this situation, with your permission, they will inform people who are important to you. You can ask your health care professional for more information on CPR decisions if you would find this helpful. Remember that CPR is only one aspect of the ReSPECT form and even if CPR is not recommended the plan can recommend other treatments that would be beneficial for you.

What does it NOT cover?

The ReSPECT form does not allow you to demand treatments that are not likely to benefit you and would not be offered. The recommendations on the form are not legally binding, but they can help to ensure that you get the appropriate treatment that is best for you and in line with your wishes.

Why is this available?

In a crisis, health professionals may have to make rapid decisions about your treatment, and you may not be able to participate in making choices. The process facilitates an informed discussion about your care and treatment preferences in an emergency.

Some life-sustaining treatments involve risks of causing harm, discomfort and loss of dignity, or even the risk of dying in hospital when you may have wanted to be at home. Many people choose not to take those risks if the likelihood of benefit from treatment is small.

What is ReSPECT Plus?

In Bristol, North Somerset and South Gloucestershire (BNSSG) we have also created a secure electronic version of the form called 'ReSPECT Plus'. Many of the health care professionals that are involved in your care can create, amend and view this electronic form ensuring it always contains the most up-to-date recommendations for your care. The electronic record contains some additional information to ReSPECT (which is why we call it ReSPECT plus) to help health care professionals provide coordinated care that is in line with your wishes. For example, there are sections about how and where you would like to be cared for if you are less well and also about practicalities for your care such as equipment, medication and personal care.

Do I still need a ReSPECT form?

After discussions with you, the health care professional may complete the ReSPECT plus electronic record and then print a summary of the information on a ReSPECT form for you. ReSPECT plus is new, so some health care professionals may not be able to access the system and you may be given a handwritten ReSPECT form instead. This means it is important to have the most up to date form with you containing information about your health and clinical recommendations for treatment in an emergency.

What if I don't want to be involved in ReSPECT or ReSPECT plus?

If you do not want to have discussions about your future care and treatment with a health care professional, there are other steps you can take to try to ensure that your wishes are known about and respected. For example, you can give legal authority to someone who you would want to make decisions on your behalf, or you can try to make sure that people close to you know your preferences, so that they can help professionals to make the best decisions for you.

If you do not want your information shared electronically you can ask your health care team not to enter it onto the ReSPECT plus record.

Where can I get more information?

Ask your health care professional for more information, or visit the following web page:

• Resuscitation Council UK (www.resus.org.uk)