重症监护病房死亡后与家属沟通器官和组织捐赠（COMFORT）：一项多中心前后对照研究。

Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT): a multicentre before-and-after study.

作者信息

Potter Julie E, Perry Lin, Elliott Rosalind M, Aneman Anders, Brieva Jorge L, Cavazzoni Elena, Cheng Andrew Th, O'Leary Michael J, Seppelt Ian M, Herkes Robert G

机构信息

NSW Organ and Tissue Donation Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia.

Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.

出版信息

Crit Care Resusc. 2018 Dec;20(4):268-276.

PMID:30482134

Abstract

OBJECTIVE

To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates.

DESIGN

A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls.

SETTING

Nine Australian intensive care units.

PARTICIPANTS

Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged ≤ 16 years.

INTERVENTION

A multicomponent intervention including offers of deceased organ donation from specially trained designated requesters using a structured conversation separate to end-of-life discussions.

MAIN OUTCOME MEASURE

Proportion of families consenting to organ donation.

RESULTS

Consent was obtained in 87/164 cases (53%) during the intervention period compared with 14/25 cases (56%) pre-intervention ( = 0.83). The odds ratio (OR) of obtaining consent during the intervention period relative to preintervention was 1.13 (95% CI, 0.48-2.63; = 0.78). During the intervention period, designated requesters obtained consent in 55/98 cases (56%), compared with 32/66 cases (48%) in which the medical team managing patient care raised donation ( = 0.34). Factors independently associated with increased consent were: family-raised organ donation (OR, 4.34; 95% CI, 1.79-10.52; = 0.001), presence of an independent designated requester (OR, 3.84; 95% CI, 1.35- 10.98; = 0.012), and multiple donation conversations per case (OR, 3.35; 95% CI, 1.93-5.81; < 0.001). Consent decreased when patients were of non-Christian religion (OR, 0.18; 95% CI, 0.04-0.91; = 0.038) and end-of-life and donation meetings were separate (OR, 0.38; 95% CI, 0.16-0.89; = 0.026).

CONCLUSION

Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12613000815763. ClinicalTrials.gov: NCT01922310.

摘要

目的

实施一项提供已故器官捐赠的最佳实践干预措施，测试其是否能提高家属同意率。

设计

一项前瞻性队列的多中心前后对照研究，并与干预前的对照组进行比较。

地点

澳大利亚的9个重症监护病房。

参与者

照顾符合捐赠条件但未登记捐赠意愿或年龄≤16岁患者的家属及医护人员。

干预措施

一项多组分干预措施，包括由经过专门培训的指定请求者在与临终讨论分开的结构化对话中提供已故器官捐赠。

主要结局指标

家属同意器官捐赠的比例。

结果

干预期间164例中有87例（53%）获得同意，干预前25例中有14例（56%）获得同意（P = 0.83）。干预期间获得同意相对于干预前的优势比（OR）为1.13（95%CI，0.48 - 2.63；P = 0.78）。干预期间，指定请求者在98例中有55例（56%）获得同意，而负责患者护理的医疗团队提出捐赠的66例中有32例（48%）获得同意（P = 0.34）。与同意增加独立相关的因素有：家属提出器官捐赠（OR，4.34；95%CI，1.79 - 10.52；P = 0.001）、有独立的指定请求者（OR，3.84；95%CI，1.35 - 10.98；P = 0.012）以及每个病例进行多次捐赠对话（OR，3.84；95%CI，1.35 - 10.98；P < 0.001）。当患者为非基督教宗教信仰时同意率降低（OR，0.18；95%CI，0.04 - 0.91；P = 0.038），且临终会议和捐赠会议分开时同意率降低（OR，0.38；95%CI，0.16 - 0.89；P = 0.026）。