临床医生对脑死亡患者器官捐献的认知与经验
Clinicians' Perception and Experience of Organ Donation From Brain-Dead Patients.
作者信息
Kentish-Barnes Nancy, Duranteau Jacques, Montlahuc Claire, Charpentier Julien, Martin-Lefevre Laurent, Joseph Liliane, Lefrant Jean-Yves, Fieux Fabienne, Renault Anne, Thuong Marie, Chevret Sylvie, Azoulay Elie
机构信息
1Assistance Publique-Hôpitaux de Paris, Famiréa Research Group, Saint-Louis University Hospital, Paris, France. 2Biostatistics and Clinical Epidemiology research (ECSTRA) team, U1153, INSERM, Paris Diderot University, SPC, Paris, France. 3Anesthesia and Intensive Care Department, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin-Bicêtre, France. 4Université Paris Sud XI, Orsay, France. 5Assistance Publique-Hôpitaux de Paris, Saint-Louis University Hospital, Service de Biostatistique et Information Médicale, Paris, France. 6Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, Paris, France. 7Medical Intensive Care Unit, Hospital of La Roche-sur-Yon, La Roche-sur-Yon, France. 8Transplant Coordination Team, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Paris, France. 9Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes, Nîmes, France. 10Anesthesia and Intensive Care Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France. 11Cavale Blanche University Hospital, Medical Intensive Care, Brest, France. 12Intensive Care Unit, Hospital René-Dubos, Pontoise, France.
出版信息
Crit Care Med. 2017 Sep;45(9):1489-1499. doi: 10.1097/CCM.0000000000002581.
OBJECTIVE
ICU clinicians are primarily involved in organ donation after brain death of ICU patients. Their perceptions of organ donation may affect outcomes. Our objective was to describe ICU clinician's perceptions and experience of organ donation.
DESIGN AND SETTING
Cross-sectional study among physicians and nurses (90 ICUs in France). We used factorial correspondence analysis to describe categories of clinicians regarding their perceptions and experience of organ donation. Factors associated with a positive (motivating) or negative (stressful) experiences were studied using multivariate logistic regression.
PARTICIPANTS
Physicians and nurses.
MEASUREMENTS AND MAIN RESULTS
Three thousand three hundred twenty-five clinicians working in 77 ICUs returned questionnaires. Professionals who experienced organ donation as motivating were younger (odds ratio, 0.41; 95% CI, 0.32-0.53; p < 0.001), more often potential organ donors (odds ratio, 1.92; 95% CI, 1.56-2.35; p < 0.001), less likely to describe inconsistency (odds ratio, 0.43; 95% CI, 0.23-0.8) or complexity (odds ratio, 0.55; 95% CI, 0.45-0.67) of their feelings versus their professional activity, less likely to report that organ donation was not a priority in their ICU (odds ratio, 0.68; 95% CI, 0.55-0.84), and more likely to have participated in meetings of transplant coordinators with relatives (odds ratio, 1.71; 95% CI, 1.37-2.14; p < 0.001). Professionals who felt organ donation was stressful were older (odds ratio, 1.84; 95% CI, 1.34-2.54; p < 0.001), less often physicians (odds ratio, 0.58; 95% CI, 0.44-0.77; p < 0.001), more likely to describe shift from curative care to organ donation as emotionally complex (odds ratio, 1.83; 95% CI, 1.52-2.21; p < 0.001), care of relatives of brain-dead patients as complex (odds ratio, 1.59; 95% CI, 1.32-1.93; p < 0.001), and inconsistency and complexity of personal feelings about organ donation versus professional activity (odds ratio, 3.25; 95% CI, 1.92-5.53; p < 0.001), and more likely to have little experience with caring for potential organ donors (odds ratio, 1.49; 95% CI, 1.09-2.04).
CONCLUSIONS
Significant differences exist among ICU clinician's perceptions of organ donation. Whether these differences affect family experience and consent rates deserves investigation.
目的
重症监护病房（ICU）临床医生主要参与ICU患者脑死亡后的器官捐献工作。他们对器官捐献的看法可能会影响结果。我们的目的是描述ICU临床医生对器官捐献的看法和经历。
设计与背景
对法国90个ICU的医生和护士进行横断面研究。我们使用因子对应分析来描述临床医生在器官捐献看法和经历方面的类别。使用多变量逻辑回归研究与积极（有激励作用）或消极（有压力）经历相关的因素。
参与者
医生和护士。
测量指标与主要结果
77个ICU的3325名临床医生返回了问卷。将器官捐献视为有激励作用的专业人员更年轻（比值比，0.41；95%置信区间，0.32 - 0.53；p < 0.001），更常是潜在器官捐献者（比值比，1.92；95%置信区间，1.56 - 2.35；p < 0.001），不太可能描述其感受与专业活动之间的不一致（比值比，0.43；95%置信区间，0.23 - 0.8）或复杂性（比值比，0.55；95%置信区间，0.45 - 0.67），不太可能报告器官捐献在其ICU中不是优先事项（比值比，0.68；95%置信区间，0.55 - 0.84），更有可能参加过与亲属的移植协调员会议（比值比，1.71；95%置信区间，1.37 - 2.14；p < 0.001）。认为器官捐献有压力的专业人员年龄更大（比值比，1.84；95%置信区间，1.34 - 2.54；p < 0.001），医生比例更低（比值比，0.58；95%置信区间，0.44 - 0.77；p < 0.001），更有可能将从治愈性护理转向器官捐献描述为情感复杂（比值比，1.83；95%置信区间，1.52 - 2.21；p < 0.001），将对脑死亡患者亲属的护理描述为复杂（比值比，1.59；95%置信区间，1.32 - 1.93；p < 0.001），以及个人对器官捐献的感受与专业活动之间的不一致和复杂性（比值比，3.25；95%置信区间，1.92 - 5.53；p < 0.001），并且更有可能对护理潜在器官捐献者经验不足（比值比，1.49；95%置信区间。1.09 - 2.04）。
结论
ICU临床医生对器官捐献的看法存在显著差异。这些差异是否会影响家属的经历和同意率值得研究。
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