• "The plan is created through conversations between a person and their health professionals."

    ReSPECT website

  • The Challenge

    Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms are used to make specific clinical decisions for an individual if their heart or lungs stop working, but their use has been linked to many problems. Firstly, the forms vary within NHS Trusts and within the community setting, meaning that some people had multiple forms. There have been examples of DNACPR forms being created without the knowledge of the person or their loved ones, and patients with a DNACPR order being ‘written off as dying’ and inappropriately excluded from other treatments.

    ReSPECT is an acronym for ‘Recommended Summary Plan for Emergency Care and Treatment’. Launched in 2017, it creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. ReSPECT creates a unified and nationally recognised treatment plan that encompasses DNACPR, as well as facilitating shared decision making between the person and healthcare professionals.

  • As of Autumn 2017, ReSPECT is being implemented in eight NHS Trusts, with over 140 organisations expressing interest.

  • "We have been incredibly impressed with the thoughtfulness and rigour with which Helix approached the ReSPECT process..."

    Consultant Physician, ReSPECT working group

  • The Solution

    At the centre of the ReSPECT process is a form which is designed to guide a conversation between healthcare professionals and the patient. The first part of the conversation is about understanding the priorities for the individual in terms of their healthcare. A graphic device is used to demonstrate that there is often a compromise between sustaining life and providing comfort and dignity. The bottom half of the form is about clinical recommendations and decisions, which are made in consideration of the priorities outlined above. These clinical recommendations include a recommendation about cardiopulmonary resuscitation (CPR).

    ReSPECT includes the words ‘summary’ and ‘emergency’ in its name, and therefore by definition does not constitute a comprehensive advance care plan. A ReSPECT plan is invaluable for anyone who doesn’t have a plan, but it could form an important part of a complete care plan, or be a catalyst to further planning.

  • ReSPECT was created by a working group of clinical, academic and charity sector organisations. Helix supported the collaboration with its human-centred design process.

  • Creating a training platform for clinicians

    One of the biggest challenges in introducing a new procedure to the healthcare sector is educating and supporting the people that need to use it. Fundamental to the development of ReSPECT is the expectation that the way in which it is implemented will be significantly different to the old DNACPR forms, with a focus on conversation and consent with the patient. However clinicians get very little training in holding ‘difficult conversations’ (a controversial term in itself) and end of life care. 

    To answer this challenge, Helix created a prototype web app to provide accessible training and support to clinicians using the ReSPECT process. This concept was then developed further, and delivered to users through a collaboration between Gehan Soosaipillai (Helix Clinical Research Fellow), UCLPartners and designer Tom Stables. The training app is accessible via the ReSPECT website.