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      General practitioners’ experiences of emergency care and treatment planning in England: a focus group study

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          Abstract

          Background

          Emergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.

          Methods

          We conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis.

          Results

          GPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings.

          Conclusion

          Conceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12875-021-01486-w.

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          Most cited references 16

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          Using thematic analysis in psychology

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            Resuscitation policy should focus on the patient, not the decision

            Zoë Fritz and colleagues discuss new approaches to resuscitation decisions that incorporate broader goals of care
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              Do not attempt cardiopulmonary resuscitation (DNACPR) orders: a systematic review of the barriers and facilitators of decision-making and implementation.

              Most people who die in hospital do so with a DNACPR order in place, these orders are the focus of considerable debate.
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                Author and article information

                Contributors
                caroline.j.huxley@warwick.ac.uk
                karin.eli@warwick.ac.uk
                c.a.hawkes@warwick.ac.uk
                g.d.perkins@warwick.ac.uk
                r.george@stchristophers.org.uk
                f.e.griffiths@warwick.ac.uk
                a-m.slowther@warwick.ac.uk
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                24 June 2021
                24 June 2021
                2021
                : 22
                Affiliations
                [1 ]GRID grid.7372.1, ISNI 0000 0000 8809 1613, Warwick Medical School, , University of Warwick, ; Gibbet Hill, Coventry, CV4 7AL UK
                [2 ]GRID grid.461342.6, ISNI 0000 0000 8524 563X, St Christopher’s Hospice, ; 51-59 Lawrie Park Road, London, SE26 6DZ UK
                Article
                1486
                10.1186/s12875-021-01486-w
                8224258
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002001, Health Services and Delivery Research Programme;
                Award ID: 15/15/09
                Award Recipient :
                Categories
                Research Article
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                © The Author(s) 2021

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