Comparison of clinicians’ perceptions of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) before and during the COVID-19 pandemic

Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process encourages collaboration between clinicians, patients, and relatives on emergency care wishes and resuscitation decisions. The impact of the COVID-19 pandemic on clinicians’ views of the ReSPECT process was unknown. We examined whether there were changes in clinicians’ knowledge, skills, and attitudes regarding ReSPECT during the pandemic. Methods We conducted a cross-sectional survey of clinicians at one acute hospital in the UK. We developed a questionnaire with a defined 5-point Likert scale and asked clinicians to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). We compared their self-reported views before and during the pandemic. Results We analysed 171 questionnaire responses. Clinicians reported ReSPECT telephone discussions with relatives were more challenging (pre-pandemic median 4, IQR 3–4; during pandemic median 4, IQR 4–5; p < 0.001) and negative emotions whilst conducting these discussions with relatives increased during the pandemic (pre-pandemic median 3, IQR 2–3.5; during pandemic median 3, IQR 2–4; p < 0.001). Clinicians also reported an increase in the importance of reaching a shared understanding of decisions with patients and relatives (pre-pandemic median 4, IQR 4–5; during pandemic median 5, IQR 4–5; p < 0.001). Conclusions There were differences in clinicians’ knowledge, skills, and attitudes scores before and during the pandemic. Our findings highlighted that clinicians could benefit from training in remote ReSPECT conversations with relatives.