#39 ReSPECT and Advance Care Planning with Dr Zoe Fritz

In this episode it is my pleasure to talk with Dr Zoë Fritz, a Consultant Physician at Addenbrooke’s Hospital and ethicist. Zoe shares the catalyst for and development of the ReSPECT process, and why ReSPECT is so much more than a decision about resuscitation.

Key messages from guest

• Zoe describes the benefits of and joy she has in working both as a consultant and an ethicist and how each role shapes and informs practice. 

• Zoe describes the story of ReSPECT and her part of the development. 

• Two  trigger cases provided a catalyst for Zoe's interest in developing ReSPECT, firstly a concept the DNR indicated that as well as Do Not Resuscitate, it could also be interpreted as Do Not Review and how wrong Zoe felt this approach to be. 

• Secondly a patient with pneumonia who would not survive CPR but for whom it would be appropriate to actively review and manage.

• Zoe realised the traditional DNACPR form did not allow for the nuances of treatment needed to deliver best care.

• Too many people conflate Do Not Attempt CPR with “don’t bother”

• Zoe’s initial research revealed patient’s were receiving adequate care and Drs and nurses were mis understanding that DNACPR should mean that other treatments were withheld

• Zoe describes development of the Universal Form for Treatment Options as a way to change the approach initially to DNACPR decision making 

• The paradigm shift from DNACPR to UFTO was first that we should talk about it with everyone and second it shouldn’t be a form about a treatment to be withheld, it should be a form about what treatments should be given.

• Zoe’s research demonstrated a 47% reduction in harm for patients with an UFTO compared to a DNACPR

• Shared understanding of a patient’s condition, values and fears is the starting point for ReSPECT

Resources

• Universal Form of Treatment Options and DNACPR decisions: challenging and changing practice in the wake of the Tracey judgement 

• Read about the UFTO research mentioned by Zoe: The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care  

• Read more about the (Tacey) v Cambridge hearing and outcome

• Access ReSPECT resource 

• Find out more about the Aintree University Hospitals NHS Foundation Trust (Respondent) v James (AP) (Appellant) mentioned by Zoe

• Details about Zoe and her work

Links to podcasts relevant to this episode:

Hear Dr Erica Borgstrom discuss When Doing Nothing is Doing Everything: Podcast: When Doing Nothing is Doing Everything 

Personalised care and finding out what matters most to people: The Platinum Rule and Advance Care Planning with Dr. Harvey Max Chochinov 

Find out about DNACPR: Case Law, headlines and facts with Ken Spearpoint

Bio

Zoë Fritz is a Wellcome fellow in Society and Ethics, and a Consultant Physician in Acute medicine at Addenbrooke’s Hospital. Her research is focused on identifying areas of clinical practice that raise ethical questions and applying rigorous empirical and ethical analysis to explore the issues and find effective, feasible, person-centred solutions. She works with colleagues in the Faculties of Law and Philosophy to ensure solutions are philosophically grounded and legally robust, as well as clinically practical and acceptable to all stakeholders.

Find out more about my Bespoke Consultancy

• Service analysis for teams seeking to improve EoLC or prepare for CQC

• End of Life Care Education

• Lasting Power of Attorney Consultancy

• Talks and presentations

If you’d like to find out more about my work contact me.

What one thing will you do?

It would be great to share what resonated with you from this episode, what is the one thing you will do differently? Head to Twitter, Facebook or LinkedIn to continue these important conversations.

Thanks to all my guests for working with me to share their knowledge, experience and stories about Advance Care Planning. I hope you enjoyed listening and have insights to take away; I love hearing your reflections on the series and look forward to reviews on Spotify where you can also subscribe to the series.

Clare

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