Ethical Aspects in Clinical Practice: Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Conversations and Death Certification Processes Among NHS Clinicians

TL;DR

This study explores how UK NHS clinicians feel underprepared for ReSPECT conversations and death certification, highlighting the need for better training and support.

Contribution

The study identifies specific training gaps and proposes targeted interventions to improve clinician confidence in end-of-life care discussions.

Findings

Most clinicians lacked formal training in ReSPECT discussions and death certification.

Workshops and seminars were seen as the most effective training method.

Fear of causing distress and time constraints were major challenges in ReSPECT conversations.

Abstract

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) supports shared decision-making about emergency and end-of-life care, while death verification and certification are essential legal and professional responsibilities for clinicians; however, many clinicians feel underprepared for these tasks.

Aim: This study aimed to identify gaps in confidence and training and to contribute to a more thoughtful and compassionate approach in preparing clinicians for some of the most challenging but deeply meaningful parts of their role.

Methods: A cross-sectional online questionnaire-based survey was conducted amongst 109 medical doctors in active clinical roles from across the NHS trusts in the UK. A Cronbach’s alpha value of 0.84 indicated that the questionnaire is a reliable tool for measuring the intended constructs. The data were analysed using IBM SPSS Statistics Version 30.0 (IBM Corp., Armonk, USA).

Results: There were 63 (57.8%) international medical graduates (IMGs) and 46 (42.2%) UK graduates. Time constraint (48.6%) and fear of causing distress (42.2%) were the most common challenges faced during ReSPECT discussions. The majority of the participants had not received any formal training in conducting ReSPECT discussions (74.3%) and death certification processes (60.6%). Workshops/seminars (56.0%) were reported to be the most effective type of training/support pertaining to death verification and certificate forms.

Conclusion: A large proportion of clinicians did not receive proper training in the domains of ReSPECT and death verification. Therefore, greater emphasis should be placed on providing clinicians with appropriate formal training, clear guidelines and protocol, and ongoing support to help them feel more confident in initiating end-of-life discussions.