Life In The Slower Lane

Here is the structured PICO analysis for the third article you uploaded:

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Full Title (verbatim and exact):

“Using the Recommended Summary Plan for Emergency Care and Treatment in Primary Care: a mixed methods study”

Anne-Marie Slowther et al.

Health and Social Care Delivery Research 2024; 12(42).

DOI: https://doi.org/10.3310/NVTF7521

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Type of Article:

Mixed methods study (qualitative interviews, focus groups, surveys, form evaluation)

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PICO Analysis:

Population:

• Adults in primary care and care home settings across 13 general practices and 13 care homes in England
• Included:
  • General practitioners (GPs)
  • Primary care nurses
  • Care home staff
  • Patients and relatives
  • People with learning disabilities and their carers
  • Broader community members (via public and GP surveys)
• Special attention to patients with life-limiting illness, frailty, and those at risk of deterioration 

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Intervention:

• Use of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form and process
  • Designed to document person-centred emergency care preferences and recommendations (e.g. CPR, escalation decisions)
  • Emphasised shared decision-making between clinicians, patients, and families
  • Evaluated how it is implemented, experienced, and understood across settings

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Comparator:

• No formal comparison group
  • However, some internal comparisons were drawn between users of ReSPECT and users of standalone DNACPR forms
  • Qualitative exploration included comparison of experience in different care settings and clinician types (e.g., GP vs. hospital) 

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Outcome:

1. Person-centred outcomes:

• Patient and family understanding, trust, and confidence in having preferences respected
• Degree to which patient preferences were recorded on the ReSPECT form (57% of forms)
• Impact on family burden during emergency decision-making

2. Process outcomes:

• Use and completion quality of ReSPECT forms (e.g., CPR section completed in 37%; 87% had treatment recommendations beyond CPR)
• Degree of staff comfort and readiness to have emergency care conversations
• Variability in interpretation and implementation of recommendations during emergencies
• Ethical themes: autonomy, best interests, clarity of responsibility

3. Health system outcomes:

• Highlighted implementation challenges, including time constraints, variable access to forms, and lack of electronic interoperability
• Emphasised need for shared systems, consistent terminology, and clarity of recommendations to reduce conflict in emergencies
• Contributed to future policy and practice recommendations for integrating ECTPs across care settings 

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