Macvean Emily, Yuen Eva Yn, Tooley Gregory, Gardiner Heather M, Knight Tess
Deakin University, Australia.
Temple University, USA.
J Health Psychol. 2020 Sep;25(10-11):1601-1611. doi: 10.1177/1359105318765619. Epub 2018 Apr 4.
Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.
由于专业医院的医生有责任识别并推动器官捐赠机会，他们对提高澳大利亚不理想的器官捐赠率有着直接影响。本文对澳大利亚医生在这一责任方面的态度进行了研究。研究采用建构主义扎根理论和情境分析方法，共采访了12名重症监护病房医生和3名急诊科医生。研究发现了一个主要主题，即医生在维护患者及其近亲的最大利益与在这种情况下的照护职责之间存在利益冲突。与此主要主题相关的两个子主题如下：（1）关于器官捐赠的讨论以及谁最适合进行这些讨论；（2）确定器官捐赠是否属于临终关怀的一部分，包括避免使用非治疗性通气，以及急诊科医生在遵循临床触发因素方面存在一定的不情愿。总体而言，参与者表示强烈支持器官捐赠，但不认为这是临终关怀的一部分，这是支持潜在捐赠机会的一个主要障碍。研究结果对医生的教育和培训具有启示意义。需要持续努力将器官捐赠的可能性纳入重症监护病房和急诊科的临终关怀中。
