van Oosterhout Sanne P C, van der Niet Anneke G, Abdo Wilson F, Boenink Marianne, van Gurp Jelle L P, Olthuis Gert
Ethics of Healthcare Group, Department of IQ Health, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Intensive Care Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Crit Care. 2024 Dec 27;28(1):434. doi: 10.1186/s13054-024-05198-2.
Listening and responding to family concerns in organ and tissue donation is generally considered important, but has never been researched in real time. We aimed to explore in real time, (a) which family concerns emerge in the donation process, (b) how these concerns manifest during and after the donor conversation, and (c) how clinicians respond to the concerns during the donor conversation.
A qualitative embedded multiple-case study in eight Dutch hospitals was conducted. Thematic analysis was performed based on audio recordings and direct observations of 29 donor conversations and interviews with the family members involved (n = 24).
Concerns clustered around six topics: 1) Life-event of a relative's death, 2) Dying well, 3) Tensions and fears about donation, 4) Experiences of time, 5) Procedural clarity, and 6) Involving (non-)present family. Most concerns occurred in topics 1 and 2. Clinicians mostly responded to concerns by providing information or immediate solutions, while sometimes acknowledgement sufficed. When concerns were highly charged with emotion, the clinicians' responses were less frequently attuned to families' needs. Cues of less clearly articulated concerns gained less follow-up. Then, concerns often remained or reappeared.
The identified concerns and the distinction between clearly and less clearly articulated concerns may prove valuable for clinicians to improve family support. We advise clinicians to engage with a curious, probing attitude to enhance the dialogue around concerns, elaborate on less clearly articulated concerns and identify the informational needs of the family.
在器官和组织捐赠中倾听并回应家属的关切通常被认为很重要，但从未进行过实时研究。我们旨在实时探索：（a）捐赠过程中出现了哪些家属关切；（b）这些关切在与捐赠者谈话期间及之后如何表现；（c）临床医生在与捐赠者谈话期间如何回应这些关切。
在荷兰的八家医院进行了一项定性嵌入式多案例研究。基于对29次捐赠者谈话的录音和直接观察以及对相关家庭成员的访谈（n = 24）进行了主题分析。
关切围绕六个主题展开：1）亲属死亡这一生活事件；2）善终；3）对捐赠的紧张和恐惧；4）时间体验；5）程序清晰度；6）涉及在场或不在场的家庭成员。大多数关切出现在主题1和2中。临床医生大多通过提供信息或立即给出解决方案来回应关切，而有时仅表示认可就足够了。当关切带有强烈情感时，临床医生的回应较少能契合家属的需求。表达不太清晰的关切线索得到的后续跟进较少。然后，这些关切往往会持续存在或再次出现。
所确定的关切以及清晰表达和不太清晰表达的关切之间的区别可能对临床医生改善对家属的支持很有价值。我们建议临床医生以好奇、探究的态度参与，以加强围绕关切的对话，详细阐述表达不太清晰的关切，并确定家属的信息需求。
