Secondary care consultant clinicians’ experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis

OBJECTIVE: To examine secondary care consultant clinicians’ experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. DESIGN: Semi-structured interviews following ward round observations. SETTING: Two National Health Service hospitals in England. PARTICIPANTS: Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards. ANALYSIS: Interview transcripts were analysed using thematic analysis. RESULTS: Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient’s short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient’s relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient’s illness trajectory. CONCLUSIONS: The management of uncertainty about prognoses and about patients’ emotional reactions is central to secondary care consultant clinicians’ experiences of timing and conducting ReSPECT conversations.