Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Lawson Health Research Institute, London, ON, Canada.
BMC Med. 2022 Mar 3;20(1):75. doi: 10.1186/s12916-022-02266-8.
The shortage of available organs for life-saving transplants persists worldwide. While a majority support donating their organs or tissue when they die, many have not registered their wish to do so. When registered, next of kin are much more likely to follow-through with the decision to donate. In many countries, most people visit their family physician office each year and this setting is a promising, yet underused, site where more people could register for deceased organ donation. Our primary aim was to evaluate the effectiveness of an intervention to promote organ donation registration in family physician's offices.
We developed an intervention to address barriers and enablers to organ donation registration that involved physician office reception staff inviting patients to register on a tablet in the waiting room while they waited for their appointment. We conducted a cross-sectional stepped-wedge cluster randomized controlled registry trial to evaluate the intervention. We recruited six family physician offices in Canada. All offices began with usual care and then every two weeks, one office (randomly assigned) started the intervention until all offices delivered the intervention. The primary outcome was registration for deceased organ donation in the provincial organ registration registry, assessed within the 7 days of the physician visit. At the end of the trial, we also conducted interviews with clinic staff to assess any barriers and enablers to delivering the intervention.
The trial involved 24,616 patient visits by 13,562 unique patients: 12,484 visits in the intervention period and 12,132 in the control period. There was no statistically significant difference in the percentage of patients registered for deceased organ donation in the intervention versus control period (48.0% vs 46.2%; absolute difference after accounting for the secular trend: 0.12%; 95% CI: - 2.30, 2.54; p=0.92). Interviews with clinic staff indicated location of the tablet within a waiting room, patient rapport, existing registration, confidence and motivation to deliver the intervention and competing priorities as barriers and enablers to delivery.
Our intervention did not increase donor registration. Nonetheless, family physician offices may still remain a promising setting to develop and evaluate better interventions to increase organ donation registration.
NCT03213171.
全球范围内，可供用于挽救生命的器官移植的器官短缺问题仍然存在。尽管大多数人支持在去世后捐献器官或组织，但许多人并未登记表示愿意捐献。进行登记后，家属更有可能遵循捐献的决定。在许多国家，大多数人每年都会去家庭医生的诊室就诊，因此诊室是一个很有前景但尚未充分利用的地点，可以让更多的人在那里登记成为已故器官捐献者。我们的主要目的是评估一种干预措施在家庭医生诊室中促进器官捐献登记的效果。
我们制定了一项干预措施，以解决器官捐献登记方面的障碍和促进因素，该措施涉及到医生办公室的接待员在候诊室邀请患者使用平板电脑进行登记，以便在等待预约时完成登记。我们进行了一项横断面、阶梯式楔形集群随机对照登记试验，以评估该干预措施。我们招募了加拿大的六家家庭医生诊室。所有诊室都先进行常规护理，然后每隔两周，一家诊室（随机分配）开始实施干预，直到所有诊室都实施了干预。主要结局是在医生就诊后的 7 天内，在省级器官登记处登记成为已故器官捐献者。在试验结束时，我们还对诊所工作人员进行了访谈，以评估提供干预措施的任何障碍和促进因素。
试验共涉及 13562 名患者的 24616 次就诊：干预期内有 12484 次就诊，对照期内有 12132 次就诊。干预组与对照组患者登记成为已故器官捐献者的比例没有统计学上的显著差异（48.0%比 46.2%；在考虑到季节性趋势后，绝对差异为 0.12%；95%置信区间：-2.30，2.54；p=0.92）。对诊所工作人员的访谈表明，平板电脑在候诊室中的位置、医患关系、现有的登记情况、提供干预措施的信心和积极性以及竞争优先事项是提供干预措施的障碍和促进因素。
我们的干预措施并未增加供者登记。尽管如此，家庭医生诊室仍然可能是一个很有前景的场所，可以在此开发和评估更好的干预措施来增加器官捐献登记。
NCT03213171。
