EFFECTIVENESS OF THE “QUESTIONNAIRES ON EXTRACTING INTENSION OF PRESENTING OPTIONS FOR ORGAN DONATION” TO MAKE ORGAN-DONATION-RELATED BEHAVIORS IN EMERGENCY MEDICAL CENTER

Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior at emergency medical centers. The subject is a family member of a patient who was transported by a tertiary emergency and died within a week....

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Published inJournal of The Showa University Society Vol. 80; no. 6; pp. 546 - 556
Main Authors TOGO, Shuusuke, GESHI, Eiichi, TANAKA, Shin, KUMAZAWA, Mayumi, TSUBAKI, Michihiro
Format Journal Article
LanguageJapanese
Published The Showa University Society 2020
昭和大学学士会
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Online AccessGet full text
ISSN2187-719X
2188-529X
DOI10.14930/jshowaunivsoc.80.546

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Abstract Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior at emergency medical centers. The subject is a family member of a patient who was transported by a tertiary emergency and died within a week. The intervention in this study is the provision of organ donation options using a questionnaire. We randomized the families of patients transported to the emergency medical center and presented the intervention group with organ donation options. The patient was followed up for one week, and the families of the deceased patients were mailed a self-administered questionnaire 8 weeks after death. Responses were received from 111 (36.3%). There were no changes in organ donation-related behaviors in 51 intervention groups (45.9%) who received the option. When the subjects were stratified, patients were of Working-age population between 15 and 65 (Working age: 66.7% vs. Dependent age: 12.5%, p=0.04), families were women (women: 24.1% vs. men: 3.1%, p=0.02), and families were confused (was confused: 40.0% vs. wasn’t confused: 0.0%, p=0.004), there was an increase in “family discussions” an action related to organ donation. When presenting Organ donation options, 17.4% felt distrust and 28.3% felt stress. Although the effect of option presentation via a questionnaire on the related behavior of organ donation is limited, it is considered an effective strategy at the initial stage of option presentation. This strategy makes it possible to present the option without the attending physician and is a versatile approach in many facilities.
AbstractList Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior at emergency medical centers. The subject is a family member of a patient who was transported by a tertiary emergency and died within a week. The intervention in this study is the provision of organ donation options using a questionnaire. We randomized the families of patients transported to the emergency medical center and presented the intervention group with organ donation options. The patient was followed up for one week, and the families of the deceased patients were mailed a self-administered questionnaire 8 weeks after death. Responses were received from 111 (36.3%). There were no changes in organ donation-related behaviors in 51 intervention groups (45.9%) who received the option. When the subjects were stratified, patients were of Working-age population between 15 and 65 (Working age: 66.7% vs. Dependent age: 12.5%, p=0.04), families were women (women: 24.1% vs. men: 3.1%, p=0.02), and families were confused (was confused: 40.0% vs. wasn’t confused: 0.0%, p=0.004), there was an increase in “family discussions” an action related to organ donation. When presenting Organ donation options, 17.4% felt distrust and 28.3% felt stress. Although the effect of option presentation via a questionnaire on the related behavior of organ donation is limited, it is considered an effective strategy at the initial stage of option presentation. This strategy makes it possible to present the option without the attending physician and is a versatile approach in many facilities.
Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior at emergency medical centers. The subject is a family member of a patient who was transported by a tertiary emergency and died within a week. The intervention in this study is the provision of organ donation options using a questionnaire. We randomized the families of patients transported to the emergency medical center and presented the intervention group with organ donation options. The patient was followed up for one week, and the families of the deceased patients were mailed a self-administered questionnaire 8 weeks after death. Responses were received from 111 (36.3%). There were no changes in organ donation-related behaviors in 51 intervention groups (45.9%) who received the option. When the subjects were stratified, patients were of Working-age population between 15 and 65 (Working age: 66.7% vs. Dependent age: 12.5%, p=0.04), families were women (women: 24.1% vs. men: 3.1%, p=0.02), and families were confused (was confused: 40.0% vs. wasn’t confused: 0.0%, p=0.004), there was an increase in “family discussions” an action related to organ donation. When presenting Organ donation options, 17.4% felt distrust and 28.3% felt stress. Although the effect of option presentation via a questionnaire on the related behavior of organ donation is limited, it is considered an effective strategy at the initial stage of option presentation. This strategy makes it possible to present the option without the attending physician and is a versatile approach in many facilities. 救急終末期における意思決定は家族に委ねられることがほとんどであり,これには臓器提供の意思決定も含まれる.適切なタイミングによる選択肢提示は,家族による患者本人の臓器提供意思の確認や,家族同士の話し合いを促すなど,臓器提供に関連する行動のきっかけにつながる可能性が推測される.これより,アンケートを使用した臓器提供の選択肢提示が家族の行動を促す効果を検証した.対象は三次救急で搬送され,1週間以内に亡くなった患者の家族である.本研究における介入はアンケートを使用した臓器提供の選択肢提示である.介入の有無は来院した日付によって準無作為に決定した.調査は在院時の「看護記録」,介入に使用した「アンケート」,死亡から8週後に行った「郵送質問紙調査」とした.111名(36.3%)から有効回答を得た.選択肢提示介入の有(51名:45.9%),無(60名:54.1%)で臓器提供に関連する行動に差はみられなかった.対象を層別すると,患者が生産年齢(66.7% vs 12.5%,p=0.04),家族が女性(24.1% vs 3.1%,p=0.02),家族が混乱している(40.0% vs 0.0%, p=0.004),例で介入により臓器提供に関連する行動である「家族の話し合い」が増加した.アンケートが臓器提供に関連する行動を促す効果は限定的ではあるが,一部の家族において臓器提供に関連する行動を促していた.より丁寧な臓器提供の選択肢提示には段階的な介入が重要であり,初期段階の対応として有効である可能性が示唆された.
Author TOGO, Shuusuke
KUMAZAWA, Mayumi
TSUBAKI, Michihiro
TANAKA, Shin
GESHI, Eiichi
Author_FL 椿 美智博
熊沢 真弓
藤後 秀輔
田中 伸
下司 映一
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References 13) 臓器提供施設マニュアル.臓器提供施設における院内体制整備に関する研究.平成22年度.(2020年1月3日アクセス) https://www.jotnw.or.jp/files/page/medical/manual/doc/flow_chart01.pdf
10) Schoenfeld EM, Goff SL, Downs G, et al. A qualitative analysis of patients’ perceptions of shared decision making in the emergency department “Let me know I have a choice”. Acad Emerg Med. 2018;25:716-727.
16) Tumin M, Tafran K, Tang L Y, et al. Factors associated with medical and nursing students’ willingness to donate organs. Medicine (Baltimore). 2016;95:e3178. (accessed 2020 Jan 3)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998402/pdf/medi-95-e3178.pdf
9) 小山泰明,井上貴昭,中村晴美,ほか.若手救急医の臓器提供に関する意識調査 2011年と2016年の比較.日臨救急医会誌.2019;22:823-831
11) 長谷川友紀,篠崎尚史,大島伸一.ドナーアクションプログラム 良質で確実な臓器提供をめざした院内体制の構築.医のあゆみ.2011;237:381-388
6) 朝居朋子,竹田昭子,横田裕行.日本人の臓器移植に対する考え方と死後の臓器提供の選択肢提示に対する受容性に関する調査研究.移植.2019;54:151-159
1) 島崎純也,田崎 修,塩崎忠彦,ほか.救命救急センターの現況 全国救命救急センター入室症例予後調査・10万例の検討.日救急医会誌.2010;22:793-802
17) Majeed F. Saudi nursing and medical student’s knowledge and attitude toward organ donation- a comparative cross-sectional study. Int J Health Sci (Qassim). 2016;10:209-217.
2) 日本集中治療医学会,日本救急医学会,日本循環器学会.救急・集中治療における終末期医療に関するガイドライン 3学会からの提言.平成26年11月4日.(2020年6月22日アクセス)https://www.jsicm.org/pdf/1guidelines1410.pdf
21) 長谷川友紀,篠崎尚史,大島伸一.これからの10年 ドナー不足対策 ドナーアクションプログラム.移植.2009;44:217-220
5) 椿 美智博,入江慎治,小西かおる.大学生のドナーカード所有の現状および意識に関する研究.日救急看会誌.2017;19:31-39
19) 新田純子.看護師の臓器提供に対する態度と関連要因.日看科会誌.2007;27:30-38
20) Kinoshita S, Miyashita M. Evaluation of end-of-life cancer care in the ICU: perception of the bereaved family in Japan. Am J Hosp Palliat Care. 2013;30:225-230.
15) Tsubaki M, Tougo S, Kobayashi M, et al. Narrative review on attitudes toward organ donation of undergraduate nurse students. Jpn J Nurs Sci. 2020;17:e12291. (accessed 2020 Jan 3)https://onlinelibrary.wiley.com/doi/epdf/10.1111/jjns.12291
12) 中西健二.ドナー家族の死別悲嘆とその影響要因に関する文献研究.人間福祉学研究.2010;3:7-18
4) Chandler JA, Connors M, Holland G, et al. “Effective” requesting: a scoping review of the literature on asking families to consent to organ and tissue donation. Transplantation. 2017;101(5S Suppl 1):S1-S16.
7) 寶場由佳,南島友和,井手健一郎,ほか.当院におけるDonor Action Programにおける家族担当Coordinatorの役割 最期を選択すること.移植.2018;53:283-288
8) 東 彦弘,織田 順,行岡哲男,ほか.臓器・組織提供におけるオプション提示クリニカルパスの作成と導入.日救急医会誌.2011;22:837-844
14) Tsubaki M, Geshi E, Takahashi M, et al. Results of a questionnaire on how to support families of emergency patients to make organ-donation decisions by proxy. Showa Univ Med Sci. 2017;29:373-382.
18) Kraus SJ. Attitudes and the prediction of behavior: a meta-analysis of the empirical literature. Pers Soc Psychol Bull. 1995;21:58-75.
3) Cheng D, Ku P. Emergency department organ-donation card pilot study. Transplant Proc. 2009;41:1463-1465.
References_xml – reference: 5) 椿 美智博,入江慎治,小西かおる.大学生のドナーカード所有の現状および意識に関する研究.日救急看会誌.2017;19:31-39.
– reference: 7) 寶場由佳,南島友和,井手健一郎,ほか.当院におけるDonor Action Programにおける家族担当Coordinatorの役割 最期を選択すること.移植.2018;53:283-288.
– reference: 16) Tumin M, Tafran K, Tang L Y, et al. Factors associated with medical and nursing students’ willingness to donate organs. Medicine (Baltimore). 2016;95:e3178. (accessed 2020 Jan 3)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998402/pdf/medi-95-e3178.pdf
– reference: 8) 東 彦弘,織田 順,行岡哲男,ほか.臓器・組織提供におけるオプション提示クリニカルパスの作成と導入.日救急医会誌.2011;22:837-844.
– reference: 1) 島崎純也,田崎 修,塩崎忠彦,ほか.救命救急センターの現況 全国救命救急センター入室症例予後調査・10万例の検討.日救急医会誌.2010;22:793-802.
– reference: 6) 朝居朋子,竹田昭子,横田裕行.日本人の臓器移植に対する考え方と死後の臓器提供の選択肢提示に対する受容性に関する調査研究.移植.2019;54:151-159.
– reference: 21) 長谷川友紀,篠崎尚史,大島伸一.これからの10年 ドナー不足対策 ドナーアクションプログラム.移植.2009;44:217-220.
– reference: 4) Chandler JA, Connors M, Holland G, et al. “Effective” requesting: a scoping review of the literature on asking families to consent to organ and tissue donation. Transplantation. 2017;101(5S Suppl 1):S1-S16.
– reference: 12) 中西健二.ドナー家族の死別悲嘆とその影響要因に関する文献研究.人間福祉学研究.2010;3:7-18.
– reference: 17) Majeed F. Saudi nursing and medical student’s knowledge and attitude toward organ donation- a comparative cross-sectional study. Int J Health Sci (Qassim). 2016;10:209-217.
– reference: 20) Kinoshita S, Miyashita M. Evaluation of end-of-life cancer care in the ICU: perception of the bereaved family in Japan. Am J Hosp Palliat Care. 2013;30:225-230.
– reference: 15) Tsubaki M, Tougo S, Kobayashi M, et al. Narrative review on attitudes toward organ donation of undergraduate nurse students. Jpn J Nurs Sci. 2020;17:e12291. (accessed 2020 Jan 3)https://onlinelibrary.wiley.com/doi/epdf/10.1111/jjns.12291
– reference: 13) 臓器提供施設マニュアル.臓器提供施設における院内体制整備に関する研究.平成22年度.(2020年1月3日アクセス) https://www.jotnw.or.jp/files/page/medical/manual/doc/flow_chart01.pdf
– reference: 3) Cheng D, Ku P. Emergency department organ-donation card pilot study. Transplant Proc. 2009;41:1463-1465.
– reference: 10) Schoenfeld EM, Goff SL, Downs G, et al. A qualitative analysis of patients’ perceptions of shared decision making in the emergency department “Let me know I have a choice”. Acad Emerg Med. 2018;25:716-727.
– reference: 19) 新田純子.看護師の臓器提供に対する態度と関連要因.日看科会誌.2007;27:30-38.
– reference: 11) 長谷川友紀,篠崎尚史,大島伸一.ドナーアクションプログラム 良質で確実な臓器提供をめざした院内体制の構築.医のあゆみ.2011;237:381-388.
– reference: 14) Tsubaki M, Geshi E, Takahashi M, et al. Results of a questionnaire on how to support families of emergency patients to make organ-donation decisions by proxy. Showa Univ Med Sci. 2017;29:373-382.
– reference: 18) Kraus SJ. Attitudes and the prediction of behavior: a meta-analysis of the empirical literature. Pers Soc Psychol Bull. 1995;21:58-75.
– reference: 2) 日本集中治療医学会,日本救急医学会,日本循環器学会.救急・集中治療における終末期医療に関するガイドライン 3学会からの提言.平成26年11月4日.(2020年6月22日アクセス)https://www.jsicm.org/pdf/1guidelines1410.pdf
– reference: 9) 小山泰明,井上貴昭,中村晴美,ほか.若手救急医の臓器提供に関する意識調査 2011年と2016年の比較.日臨救急医会誌.2019;22:823-831.
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Snippet Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior...
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StartPage 546
SubjectTerms bereaved family survey
emergency medical center
organ donation
organ donation option
quasi-randomized controlled trial
救命救急センター
準ランダム化比較試験
臓器提供
選択肢提示
遺族調査
Title EFFECTIVENESS OF THE “QUESTIONNAIRES ON EXTRACTING INTENSION OF PRESENTING OPTIONS FOR ORGAN DONATION” TO MAKE ORGAN-DONATION-RELATED BEHAVIORS IN EMERGENCY MEDICAL CENTER
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