Clinicians' Perception and Experience of Organ Donation From Brain-Dead Patients
Clinicians' Perception and Experience of Organ Donation From Brain-Dead Patients
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DOI：
10.1097/ccm.0000000000002687
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发表时间：
2017-09-01
影响因子：
8.8
通讯作者：
Azoulay, Elie
中科院分区：
文献类型：
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作者：
Kentish-Barnes, Nancy;Duranteau, Jacques;Azoulay, Elie
目的：ICU临床医生主要参与ICU患者脑死亡后的器官捐献。他们对器官捐赠的看法可能会影响结果。我们的目的是描述 ICU 临床医生对器官捐献的看法和经验。设计和设置：医生和护士之间的横断面研究（法国 90 个 ICU）。我们使用因子对应分析来描述临床医生对器官捐赠的看法和经验的类别。使用多元逻辑回归研究与积极（激励）或消极（压力）经历相关的因素。参与者：医生和护士。测量和主要结果：77 个 ICU 工作的 3325 名临床医生返回了调查问卷。经历器官捐赠激励的专业人士更年轻（比值比，0.41；95% CI，0.32-0.53；p < 0.001），更多的是潜在的器官捐献者（比值比，1.92；95% CI，1.56-2.35；p < 0.001），描述不一致的可能性较小（比值比，0.43；p < 0.001）。他们的感受与职业活动的 95% CI，0.23-0.8）或复杂性（比值比，0.55；95% CI，0.45-0.67），不太可能报告器官捐赠不是 ICU 的优先事项（比值比，0.68；95% CI，0.55-0.84），并且更有可能参加移植协调员与亲属的会议（比值比，1.71；95% CI，1.37-2.14；p < 0.001）。感到器官捐献有压力的专业人员年龄较大（比值比，1.84；95% CI，1.34-2.54；p < 0.001），医生较少（比值比，0.58；95% CI，0.44-0.77；p < 0.001），更有可能将从治疗护理转向器官捐献描述为情绪复杂（比值比， 1.83；95% CI，1.52-2.21；p < 0.001），脑死亡患者亲属的护理复杂（比值比，1.59；95% CI，1.32-1.93；p < 0.001），以及对器官捐献与职业活动的个人感受的不一致和复杂性（比值比，3.25；95% CI， 1.92-5.53；p < 0.001），更有可能缺乏照顾潜在器官捐献者的经验（比值比，1.49；95% CI，1.09-2.04）。结论：ICU 临床医生对器官捐献的看法存在显着差异。这些差异是否影响家庭经历和同意率值得调查。
Objective: ICU clinicians are primarily involved in organ donation after brain death of ICU patients. Their perceptions of organ donation may affect outcomes. Our objective was to describe ICU clinician's perceptions and experience of organ donation.Design and Setting: Cross-sectional study among physicians and nurses (90 ICUs in France). We used factorial correspondence analysis to describe categories of clinicians regarding their perceptions and experience of organ donation. Factors associated with a positive (motivating) or negative (stressful) experiences were studied using multivariate logistic regression.Participants: Physicians and nurses.Measurements and Main Results: Three thousand three hundred twenty-five clinicians working in 77 ICUs returned questionnaires. Professionals who experienced organ donation as motivating were younger (odds ratio, 0.41; 95% CI, 0.32-0.53; p < 0.001), more often potential organ donors (odds ratio, 1.92; 95% CI, 1.56-2.35; p < 0.001), less likely to describe inconsistency (odds ratio, 0.43; 95% CI, 0.23-0.8) or complexity (odds ratio, 0.55; 95% CI, 0.45-0.67) of their feelings versus their professional activity, less likely to report that organ donation was not a priority in their ICU (odds ratio, 0.68; 95% CI, 0.55-0.84), and more likely to have participated in meetings of transplant coordinators with relatives (odds ratio, 1.71; 95% CI, 1.37-2.14; p < 0.001). Professionals who felt organ donation was stressful were older (odds ratio, 1.84; 95% CI, 1.34-2.54; p < 0.001), less often physicians (odds ratio, 0.58; 95% CI, 0.44-0.77; p < 0.001), more likely to describe shift from curative care to organ donation as emotionally complex (odds ratio, 1.83; 95% CI, 1.52-2.21; p < 0.001), care of relatives of brain-dead patients as complex (odds ratio, 1.59; 95% CI, 1.32-1.93; p < 0.001), and inconsistency and complexity of personal feelings about organ donation versus professional activity (odds ratio, 3.25; 95% CI, 1.92-5.53; p < 0.001), and more likely to have little experience with caring for potential organ donors (odds ratio, 1.49; 95% CI, 1.09-2.04).Conclusions: Significant differences exist among ICU clinician's perceptions of organ donation. Whether these differences affect family experience and consent rates deserves investigation.