106 Qualitative analysis of recommended summary plan for emergency care and treatment (ReSPECT) within the medicine of the elderly (MOE) directorate at the Western General Hospital

Background There has been increasing awareness of the value of high-quality anticipatory care planning (ACP) in the frail, elderly population. ACP offers patients with chronic conditions the opportunity to plan their future care and treatment, while they have capacity to do so. This personalised approach improves patient outcomes, particularly towards the end of life. In NHS Lothian there is an opportunity to create a standardised tool to record a patient‘s ACP decisions. ReSPECT is in use as an ACP form across England and Scotland. ReSPECT focuses on patient wishes and realistic treatment goals prior to an emergency situation when they cannot make or express choices. This project aimed to ascertain whether ReSPECT is a suitable ACP form for a frail, elderly inpatient population in NHS Lothian. Methods Ten medically stable MOE inpatients were approached for a discussion about their health and future wishes using the ReSPECT form. A questionnaire was created to facilitate this discussion and record responses. Results Eight of ten participants were happy to discuss future wishes. Four participants found the discussion useful. Two participants found it distressing. Only two participants found the form easy to use. Conclusions While some participants did find ACP discussions useful, the ReSPECT form was not well received amongst this inpatient sample. Barriers included difficulty understanding the form, concern that wishes were documented irreversibly, and a desire to avoid difficult topics while recovering from acute illness. In view of the barriers identified, it is clear that we must factor in both sufficient time and support to facilitate patient-centred ACP discussion. In line with patient feedback, it is likely that the best time to initiate this process is not following an acute illness, but when the person is in a period of stability. ReSPECT may be more well received if initiated in primary care.