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

简介(申请人提供)：已故捐献仍然是器官的主要来源。尽管公众表达了对器官捐赠的热情，但捐赠同意率仍然相对较低。在美国，符合捐赠条件的个人的家庭同意的比例不超过60%。提高已故捐赠者家庭的同意率是减缓供需缺口扩大的关键手段。这项拟议的为期五年的研究将测试在器官采购组织(OPO)提出请求时，使用两部分早期转诊和请求方法(ERRA)干预措施，以提高死者家属对固体器官捐赠的同意率。ERRA由以医院为基础的评估评估系统和沟通干预组成。它针对两个可能影响同意器官捐赠的关键因素：1)医院将潜在捐赠者转介给OPO的时间敏感；以及2)OPO申请者使用有效的沟通技术与符合捐赠资格的患者的家人讨论器官捐赠。ERRA的干预基于15年来在器官捐赠障碍领域的先前研究，并基于最近一项研究的结果。我们将采用实验设计，在两种情况下(自主和协助)测试ERRA干预措施的两个要素的总体效果，以确定实施ERRA的最佳做法。ERRA的第一个模块是捐赠中的医院采购障碍快速评估(RAPID)。第二个模块是关于捐赠的有效沟通(CEAD)，向OPO申请者传授沟通技能，旨在提高他们向符合捐赠者资格的家庭提出请求的有效性。分布在美国各地的八个OPO及其请求器官捐赠的OPO协调员将作为研究地点和参与者参加(n=80)。该提案有以下具体目标：目标1.测试快速培训的有效性，通过医院通知OPO以及快速培训和CEAD培训模块对同意率的影响，增加对潜在捐赠者的及时识别。目的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；b)受训的外部顾问在实施模块方面发挥作用的辅助方法。与公共卫生相关：有超过96,000名患者在等待移植名单上，但在任何一年，这些患者接受器官移植的比例都不会超过一小部分。这项研究提出了一种干预措施，以帮助提高器官捐赠率，缓解器官短缺问题。

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.