1 Famiréa Research Group and.
2 Service de Biostatistique et Information Médicale, Saint-Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Am J Respir Crit Care Med. 2018 Sep 15;198(6):751-758. doi: 10.1164/rccm.201709-1899OC.
Studies show that the quality of end-of-life communication and care have a significant impact on the living long after the death of a relative and have been implicated in the burden of psychological symptoms after the ICU experience. In the case of organ donation, the patient's relatives are centrally involved in the decision-making process; yet, few studies have examined the impact of the quality of communication on the burden of psychological symptoms after death.
To assess the experience of the organ donation process and grief symptoms in relatives of brain-dead patients who discussed organ donation in the ICU.
We conducted a multicenter longitudinal study in 28 ICUs in France. Participants were the relatives of brain-dead patients who were approached to discuss organ donation. Relatives were followed-up by phone at three time points: at 1 month, to complete a questionnaire describing their experience of the organ donation process; at 3 months, to complete the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised; and at 9 months, to complete the Impact of Event Scale-Revised and the Inventory of Complicated Grief.
In total, 202 relatives of 202 patients were included, of whom 158 consented to and 44 refused organ donation. Interviews were conducted at 1, 3, and 9 months with 78%, 68%, and 58% of relatives, respectively. The overall experience of the organ donation process was significantly more burdensome for relatives of nondonors. They were more dissatisfied with communication (27% vs. 10%; P = 0.021), more often shocked by the request (65% vs. 19%; P < 0.0001), and more often found the decision difficult (53% vs. 27%; P = 0.017). However, there were no significant differences in grief symptoms measured at 3 and 9 months between the two groups. Understanding of brain death was associated with grief symptoms; our results show a higher prevalence of complicated grief symptoms among relatives who did not understand the brain death process than among those who did (75% vs. 46.1%; P = 0.026).
Experience of the organ donation process varied between relatives of donor versus nondonor patients, with relatives of nondonors experiencing lower-quality communication, but the decision was not associated with subsequent grief symptoms. Importantly, understanding of brain death is a key element of the organ donation process for relatives.
研究表明，临终沟通和护理质量对亲属在亲人去世后的生活质量有重大影响，并与 ICU 经历后的心理症状负担有关。在器官捐献的情况下，患者的亲属是决策过程的核心参与者；然而，很少有研究探讨沟通质量对死亡后心理症状负担的影响。
评估在 ICU 中讨论器官捐献的脑死亡患者的亲属对器官捐献过程的体验和悲伤症状。
我们在法国 28 家 ICU 进行了一项多中心纵向研究。参与者是被邀请讨论器官捐献的脑死亡患者的亲属。通过电话在三个时间点对亲属进行随访：1 个月时，完成一份描述他们对器官捐献过程体验的问卷；3 个月时，完成医院焦虑抑郁量表和修订后的事件影响量表；9 个月时，完成修订后的事件影响量表和复杂悲伤量表。
共有 202 名患者的 202 名亲属参与了研究，其中 158 人同意，44 人拒绝器官捐献。分别有 78%、68%和 58%的亲属在 1、3 和 9 个月时接受了访谈。总体而言，未捐献者亲属对器官捐献过程的体验更具负担。他们对沟通的满意度明显较低（27%比 10%；P=0.021），对请求的震惊程度更高（65%比 19%；P<0.0001），而且更经常觉得决策困难（53%比 27%；P=0.017）。然而，两组在 3 个月和 9 个月时的悲伤症状测量均无显著差异。对脑死亡的理解与悲伤症状有关；我们的结果显示，对脑死亡过程不理解的亲属中复杂悲伤症状的患病率高于理解的亲属（75%比 46.1%；P=0.026）。
供者和非供者患者亲属的器官捐献过程体验不同，非供者亲属的沟通质量较低，但该决定与随后的悲伤症状无关。重要的是，对脑死亡的理解是亲属器官捐献过程的一个关键因素。
