Communicating Effectively about Organ Donation: A Randomized Trial of a Behavioral Communication Intervention to Improve Discussions about Donation.

Refusing requests for solid organ donation at the bedside is a major barrier to increasing the supply of transplantable organs. Nationwide, it has been estimated that requests for organ donation result in family authorization rates of approximately 65%.1 Data from a study of 30 organ procurement organizations (OPOs) conducted by the association of OPOs reported widely varying referral and request rates ranging from 65% to 99%.2 Little has changed in the past decade, with recent reports from two geographically distinct OPOs placing authorization rates at 58%.3,4 The importance of this issue is memorialized in the numerous legislative attempts to improve the request process since the 1980s2,5-9 and the Institute of Medicine report emphasizing the need to improve the quality of the authorization process and the success of donation requests.10 Communication Is Key to Successful Requests Successful requests for organ donation involve communicating with families about the option to donate in a way that provides sufficient information to make an informed decision. Obtaining authorization does not consist of simply asking families if they wish to donate. Effective requests require adequate time for requesters to assess each family’s unique situation and plan an approach that acknowledges and supports their grief but still achieves the goal of obtaining authorization. Families also need to be prepared for the request. Families who are surprised by the donation request or who feel harassed or pressured to make a decision are less likely to donate than families who do not.1 Once the request is made, families also need time to ask questions and discuss the request.11 Displays of empathy, sensitivity, and support contribute to families’ receptiveness.12,13 Discussion of key topics, including brain death, how the body is handled, funeral arrangements, patient’s wishes concerning donation, donation cost and providing statistical information about the benefits of donation, is critical because many Americans have fears and beliefs that are impediments to organ donation.2,14-24 Communicating Effectively About Donation Intervention Communicating Effectively About Donation (CEaD) is designed to provide didactic and skills-based training to OPO staff through exposure to the theoretical bases for relational and instrumental communication and key communication skills and behaviors proven effective in obtaining authorization for organ donation. Originally developed as an in-person communication skills training program, using simulated cases,25 the CEaD was adapted for online delivery in recognition of the limited availability and expense of simulators and the time constraints of OPO staff. This paper reports on a national test comparing two versions of the CEaD—online plus in-person training versus on-line training only. Requesters assigned to CEaD1 viewed a series of 4 donation scenarios of increasing difficulty embedded within a web-based tutorial (www.ceadtraining.org; Website access may be secured through written request to the first author). Each scenario depicted trained medical simulators using basic communication skills in approaches to families of potential brain dead eligible patients (see Appendix for descriptions). An accompanying workbook detailed the specific skills needed to effectively initiate the request, gather information from families and give information about donation, elicit donation beliefs, build relationships, and close the discussion. Requesters assigned to the CEaD2 condition received the same training described above supplemented with live practice and feedback using simulated family scenarios (see Appendix). All simulators participated in a day-long training session and were instructed to allow requesters’ behavior to dictate the donation decision. If the requester addressed concerns raised about donation and appropriately employed a majority of the CEaD skills, the simulators authorized donation. After the simulation, requesters were provided with feedback about their performance. Our primary hypothesis was that either version of the CEaD would increase the rate of family authorization for organ donation and improve the quality of OPO requesters’ communication with families. We also hypothesized that OPO requester characteristics would be associated with training effectiveness.