Blog / ReSPECT User Interface

Jonathan Waldheim: March 05, 2021

Around this time last year, I wrote a blog about how we changed the ReSPECT application. We used the NHS Digital Design System to put the new user interface together and felt that the experience of the application improved.  

Of course, a lot has happened in the last year, not least the impact of Coronavirus on the work that we have prioritised. So, on the final day of our ReSPECT week, I’m going to give you a quick update on what has changed since I wrote that blog.  

Version 3.0 of the ReSPECT Form 

The digital ReSPECT we are creating at NDS is based on the form designed by the Resuscitation Council UK (RCUK).  

In September 2020, the form was updated from version 2.0 to 3.0 

What’s new in the form? 

The Resuscitation Council UK put together this really helpful table explaining the changes and the reasons for the updates to the form:

What you will see in version 3 

Reason for the change 

Inclusion of a statement about the process being based around a conversation.  

States that the recorded recommendations are not legally binding. 

Puts the focus on the conversation and the individual’s perspective. 

Makes clearer to the user the recorded recommendations are not legally binding.  

Changes to the wording in section 2 to encourage clinicians to record information about the person’s personal circumstances. Section is now called ‘Shared understanding of my health and current condition’. 

The question about whether the person has a legal proxy has been moved from the back of the form to the front in section 2.  

Puts more emphasis on shared understanding of the situation between the professional and patient. 

  

 
Enables recording earlier in the process of whether the person has a legal proxy.  
  

The scale in section 3 ‘What matters to me in decisions about my treatment and care in an emergency’ has been converted to a visual aid. 

In the previous version people were given an option to mark on the scale where they viewed their wishes between prioritising sustaining life and prioritising comfort.  This caused some confusion to people and often they did not complete this section. 

In section 3 ‘What matters to me in decisions about my treatment and care in an emergency’, the patient is now asked what they most value and what they fear most/wish to avoid. 

This is important information that supports better understanding of the patient and their needs, and clearer recording of what matters to them. 

In section 4 ‘clinical recommendations for emergency care and treatment’, the language has been made more personable. 

Feedback from patients and the public highlighted the need for more personable language. 

In section 4 ‘clinical recommendations for emergency care and treatment’ a third option has been made available – the ability to record a clinical recommendation to balance extending life with comfort and valued outcomes. 

This additional option reflects the fact that for some patients, based on their values, a balanced approach will be the recommendation. Feedback was that the previous form gave the impression that the clinician needed to make a binary decision which often did not reflect the patient’s realistic preferences. 

In section 5 ‘Capacity for involvement in making this plan’ the wording has been changed to ensure that when decisions are made without involving the patient, the reasons for this are clearly recorded. There is also an important reminder that if the person lacks capacity a ReSPECT conversation must take place with the legal proxy and/or family. 

Provides clearer wording to encourage clinicians to record clearly in what way the person lacks capacity and the reason why the patient wasn’t involved in the conversation.  

The reminder about involving the legal proxy and/or family will help ensure that the legal proxy and/or family is always involved in making best-interest decisions when the patient lacks mental capacity for those decisions. 

The option for patient/legal proxy or family member to sign the document to allow them to show they have been actively involved in the discussion and recommendations about their/their family member’s care and treatment. 

We had received feedback from some patients, families and clinicians that they would value the ability for a person/their legal proxy or family member to sign the document to confirm their involvement in the conversation and recorded recommendations. 

 

What’s new in the app? 

The application has been updated to reflect all of the changes above but has also some other new developments which I’d like to talk about. 

NHS Scotland Branding 

User interface

The eagle eyed amongst you might have noticed that the app was previously NHS UK branded. As our role is to offer infrastructure, data and applications to NHS Scotland, we thought it would be useful to rebrand accordingly.  

Discussion guide 

During the first spike of the pandemic, we spent a lot of time working with Healthcare Improvement Scotland on a light touch Anticipatory Care Plan.  

One of the features of this work was a discussion guide based on the REDMAP conversation framework developed by Effective Communication for Healthcare.  

This tested well with users and we decided that the ReSPECT application could use this as well. It is now included for people who need a little guidance around the conversation or a reminder of some of the prompts. 

What else is to come 

The user interface we have designed so far is for secondary and primary care users of the application.  

After that, we’ll be looking to provide access to the data for unscheduled care services. Then, the logical next steps would be to provide access for: 

  • Social care, including care homes 
  • Patients and their families 

We won’t jump in to visualising this immediately however, as our first task is to understand the needs of all of these user groups.  

But when we do start to design new interfaces, we’ll be sure to share more on the blog! 

End of ReSPECT week 

I hope you’ve enjoyed the content we shared this week about ReSPECT. We’re looking forward to: 

As always, if you want to chat about Digital ReSPECT or the National Digital Platform feel free to send me an e-mail or Tweet @NDSScotland.

 

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