Chandler Jennifer A, Connors Matthew, Holland Giles, Shemie Sam D
1 Faculty of Law, University of Ottawa, Ottawa, ON, Canada. 2 Bertram Loeb Research Chair, University of Ottawa, Ottawa, ON Canada. 3 Division of Critical Care, Montreal Children's Hospital, McGill University, Montreal, QC, Canada. 4 Deceased Donation, Canadian Blood Services, Ottawa, ON, Canada.
Transplantation. 2017 May;101(5S Suppl 1):S1-S16. doi: 10.1097/TP.0000000000001695.
Families are often asked to consent to the donation of their deceased relative's organs or tissues. These end-of-life conversations are important because they affect consent rates as well as the psychological impact of the decision for families. This scoping review of the literature on requesting family consent was prepared to support of the development of leading practice recommendations for end-of-life conversations with families of potential donors. A scoping review maps research activity in a field across a range of commentary and empirical study designs but does not attempt meta-synthesis of empirical data or quality assessment.
We performed a scoping review of the peer-reviewed literature from January 2000 to February 2015 on the questions of what constitutes an "effective" request and the factors that affect consent rates and family satisfaction with their decision and the process. This review includes a final set of 168 articles addressing (a) whether, when, and how to ask families for consent to donation or (b) characteristics of families or decedents that affect families' decisions or family satisfaction with their decisions.
Six main themes were identified: (1) the objectives of requesting and encouraging family consent to donation, (2) the effect of the donation decision on family well-being, (3) the process of requesting family consent, (4) the impact of the quality of the care for the deceased and for the family, (5) the content and manner of the request for family consent, and (6) the characteristics of the family and deceased that affect the request for family consent.
This scoping review found that there is a large literature on how to modify the process and manner of the request to increase family consent rates. Another important line of inquiry focuses on the psychological impact of the decision on the family. Although a scoping review does not attempt to synthesize results or draw evidence-based conclusions, the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) and is best for both consent rates and family well-being. Although the presumption is often that the primary objective of asking for family consent is to secure consent and donation, some ethical commentary on requesting consent emphasizes that this objective must be balanced with the parallel obligation to protect the psychological well-being of families. This places some constraints on the approaches used in family consent discussions.
家属经常被要求同意捐赠其已故亲属的器官或组织。这些临终谈话很重要，因为它们会影响同意率以及家属做出该决定后的心理影响。本次对关于征求家属同意的文献的范围综述，旨在为制定与潜在捐赠者家属进行临终谈话的最佳实践建议提供支持。范围综述梳理了一系列评论和实证研究设计领域内的研究活动，但不尝试对实证数据进行元综合或质量评估。
我们对2000年1月至2015年2月间同行评议文献进行了范围综述，内容涉及什么构成“有效”请求、影响同意率以及家属对其决定和过程满意度的因素等问题。本综述最终纳入了168篇文章，这些文章探讨了以下内容：(a) 是否、何时以及如何征求家属对捐赠的同意；(b) 影响家属决定或家属对其决定满意度的家属或死者的特征。
确定了六个主要主题：(1) 征求并鼓励家属同意捐赠的目标；(2) 捐赠决定对家属福祉的影响；(3) 征求家属同意的过程；(4) 对死者及家属的护理质量的影响；(5) 征求家属同意的内容和方式；(6) 影响征求家属同意的家属和死者的特征。
本次范围综述发现，有大量文献探讨了如何改变请求的过程和方式以提高家属同意率。另一个重要的研究方向关注该决定对家属的心理影响。虽然范围综述不尝试综合结果或得出基于证据的结论，但文献总体上支持一些直观的预期，即对死者和家属给予同情和尊重的护理、倾听并解决家属的担忧，以及对捐赠持积极态度（但不仅仅以获取为重点），这对同意率和家属福祉都最为有利。尽管通常认为征求家属同意的主要目标是获得同意和捐赠，但一些关于征求同意的伦理评论强调，这一目标必须与保护家属心理健康的同等义务相平衡。这对家属同意讨论中使用的方法施加了一些限制。
