A Randomized Trial of the ERRA Intervention to Increase Consent to Organ Donation

描述（由申请人提供）：死者捐赠仍然是器官的主要来源。尽管公众对器官捐赠表示热情，但捐赠同意率仍然相对较低。在美国，不超过60%的符合捐赠资格的个人的家庭同意。提高已故捐献者家庭的同意率是减缓供需差距扩大的关键手段。这项为期五年的研究将测试两部分早期转诊和请求方法（ERRA）干预的使用，以提高器官采购组织（OPO）提出请求时已故患者家属对实体器官捐赠的同意率。ERRA包括一个以医院为基础的评估系统和一个沟通干预。它针对两个关键因素，可以使不同的同意器官捐赠：1）由医院的潜在捐赠者患者的时间敏感转介到OPO;和2）OPO请求者使用有效的沟通技巧，讨论器官捐赠与捐赠合格的患者家属。ERRA的干预措施是基于15年来在器官捐赠障碍领域的研究，并以最近的一项研究结果为基础。我们将使用一个实验设计，以测试两个要素的ERRA干预两种条件下（自主和协助）的整体效果，以确定ERRA实施的最佳实践。ERRA的第一个模块是医院采购捐赠障碍快速评估（RAPiD）。第二个模块是关于捐赠的有效沟通（CEaD），教授OPO请求者沟通技巧，旨在提高他们向符合捐赠资格的家庭提出请求的有效性。位于美国各地的8家OPO及其要求器官捐献的OPO协调员将作为研究中心和参与者参加（n=80）。该提案有以下具体目标：目标1。测试RAPiD通过医院通知OPO增加及时识别潜在供体的有效性，以及RAPiD和CEaD培训模块对同意率的影响。目标2.在两种情况下测试RAPiD和CEaD模块的OPO实现。要测试的两个实施条件是：a）完全自主的条件，即业务干事不雇用任何外部援助来实施模块，和B）辅助方法，即受过培训的外部顾问在实施模块中发挥作用。公共卫生相关性：有超过96，000名患者在移植等待名单上，但在任何一年中，这些患者中只有一小部分会接受器官移植。这项研究提出了一种干预措施，以帮助提高器官捐献率，缓解器官短缺。

DESCRIPTION (provided by applicant): Deceased donation remains the major source of organs. Despite the public's stated enthusiasm for organ donation, donation consent rates have remained relatively low. In the U.S. no more than 60% of the families of donation-eligible individuals consent. Improving the rates of consent from deceased donor families is a pivotal means for slowing the rise of the supply-demand gap. The proposed five-year study will test the use of a two-part Early Referral and Request Approach (ERRA) intervention to raise consent rates to solid organ donation from the families of deceased patients at the point where requests are made by Organ Procurement Organizations (OPOs). The ERRA consists of a hospital-based evaluation assessment system and a communication intervention. It targets two key factors that can make a difference to consent to organ donation: 1) time-sensitive referrals by hospitals of potential donor patients to the OPO; and 2) use of effective communication techniques by OPO requesters to discuss organ donation with donation-eligible patients' families. The ERRA intervention is based on 15 years of prior research in the area of obstacles to organ donation and is grounded in the results of a recent study. We will use an experimental design to test the overall efficacy of both elements of the ERRA intervention under two conditions (autonomous and assisted) to ascertain best practices for ERRA implementation. The first module of the ERRA is the Rapid Assessment of Hospital Procurement barriers in Donation (RAPiD). The second module is the Communicating Effectively about Donation (CEaD) that teaches OPO requesters communication skills designed to improve the effectiveness of their requests to donor-eligible families. Eight OPOs, located around the United States, and their OPO coordinators who request organ donation, will participate as study sites and participants (n=80). The proposal has the following specific aims: Aim 1. Test the effectiveness of the RAPiD to increase timely identification of potential donors through hospital notification of OPOs and the affect of the RAPiD and CEaD training modules on consent rates. Aim 2. Test OPO implementation of the RAPiD and CEaD modules under two conditions. The two implementation conditions to be tested are: a) a completely autonomous condition in which an OPO does not employ any outside assistance to implement the module, and b) an assisted method whereby trained outside consultants play a role in implementing the modules. PUBLIC HEALTH RELEVANCE: There are over 96,000 patients on the transplantation waiting list but no more than a fraction of these patients will receive an organ transplant in any given year. This study proposes an intervention to help increase the rates of organ donation and alleviate the organ shortage.