Bradford VTS Online Resources:
- OSCEs in Palliative & Cancer Care (BVTS)
- WMPCP Symptom Control in Palliative Care website (Amazing!)
- WMPCP Symptom Control in Palliative Care as a pdf
- CLiP (Newcastle) – these 15 min worksheets are brilliant!
- The Other Side – a true story of one doctor’s journey as a patient coming to terms with a terminal cancer diagnosis
- CRUK – diagnostic tools for use in cancer
- CRUK – causes of cancer and ways to reduce risk
- CRUK – cancer treatment and other post-diagnosis issues
- CRUK – cancer statistics
- CRUK – cancer screening
- CRUK – learning, support and resources for health professionals
ReSPECT is replacing DNACPR
What is it
- Recommended Summary Plan for Emergency Care & Treatment
- A personalised future emergency plan. One section of the Advanced Care Plan umbrella – specifically focusing on “in the event of an emergency”.
Why ReSPECT? What was wrong with DNACPR?
- DNACPR – often negative for patients (because they are not involved), and negative for docs (who don’t like doing it/making decisions on patients without involving them)
- So, ReSPECT encourages us, health professionals, to INVOLVE the patient – it is there life after all. And to involve them EARLY rather than late on when they might not be in a state to make decisions.
In practice, how does it translate?
- We should be presumptive in favour of patient involvement legally – i.e. just involve them in the decision making.
- Leaving someone “for CPR” when they may not want it is no less a breach of their human rights
- Where no explicit decision – there should be an initial presumption in favour of CPR
- But this DOES NOT mean the indiscriminate application of CPR that will be of no benefit and not in a person’s best interests.
Top tips in applying it
- Cover what treatment wanted AND what treatment not wanted
- Do it early – esp those end of life, at risk of cardiac arrest.
- Don’t just think the elderly. It’s for everyone, at any age.
- Remember, this is about EMERGENCY CARE & TREATMENT
- Once you have filled in the form…
- when to review?
- who keeps it?
- summarise the document verbally to the patient – i.e. what you have agreed, check understanding, make adjustments if needs be.
If in doubt, seek the opinion of your medical protection organisation and your local adult/child safeguarding team.
- If you would like to have a go at adding some “top tips” to this page for this specialty (and have your name displayed proudly with bradfordvts), please email me – [email protected]
- What if patient wants resus and as a clinician you feel it is futile
- Re-open the discussion – you need a deeper conversation.
- If you really think it is futile, and the patient still wants it, that usually means you have not explained the pros and cons well enough.
- Go back and do more discussion. This is not about you over-riding their decision, but both of you aligning your viewpoints and shared-decision making.
- What if patient’s advocate wants it, and as a clinician you feel not in patient’s best interests
- Like above, re-open the discussion – you need a deeper conversation.
- If you really think it is futile, and the advocate or relative still wants it, that usually means you have not explained the pros and cons well enough.
- Go back and do more discussion.
- If you feel as a clinician you have done your best to get a conversation going and good explanations – and that it would be futile – but the relatives still wants it – then you may need to get a court order. Talk to your medical protection organisation first. It is VERY RARE to have to go down this route.
- Does the patient’s/patient’s advocate decision override the doctors when they are at variance?
- No, it doesn’t. If you think it is futile and not in the patient’s best interests, then that is an important medical decision.
- HOWEVER, I cannot emphasise enough how you need to go back to having a discussion.
- You should not be autocratic or dictatorial when there is a variance of opinions. The variance signals the need for more discussion.
- Deeper and more meaningful discussions usually will help all parties get to the “right” decision.