Review
Background
Methods
Search strategy
Study eligibility criteria
Study quality assessment
Data extraction
Data analyses
Results
Review statistics
Study quality assessment
Population | Intervention | Assessment tool(s)a | Analysis | ||||||
---|---|---|---|---|---|---|---|---|---|
Papers | Randomization | Justification of sample size | Control group | Allocation concealment | Underlying theory | Validity | Reliability | Intention-to-treat | Attrition rate |
Alonso, Fernandez, Mataix et al. (1999) | No | Not mentioned | No | N/A | None | N/A | N/A | N/A | N/A |
Beasley, Capossela, Brigham, Gunderson and Gortmaker (1997) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Bleakley (2010) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Dettle, Sagel and Chrysler (1994) | No | No | Yes (but no statistical comparison between groups) | Not mentioned | None | Not mentioned | Not mentioned | no | 40% attrition; |
No analysis of dropouts | |||||||||
Kittur, McMenamin and Knott (1990) | No | No | Yes | Not randomly assigned | None | N/A | N/A | N/A | N/A |
Light (1987) | No | No | Yes (but no statistical comparison between groups) | Not randomly assigned | None | N/A | N/A | N/A | N/A |
Milanés, Gonzalez, Hernandez, Arminio, Clesca and Rivas-Vetencourt (2003) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Nelson, Marymont, Durand, Reyes and Davis (1992) | Random cluster probability method | No | Yes | Not randomly assigned | None | Field testing of the questionnaire (but validity/reliability assessment not detailed) | N/A | N/A | |
Niday, Painter, Peak et al. (2007) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Riker and White (1995) | No | No | Yes | Not randomly assigned | None | N/A | N/A | N/A | N/A |
Shafer, Durand, Hueneke, et al. (1998) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Stark, Wikoren and Martone (1994) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Taylor, Young and Kneteman (1997) | No | No | No | N/A | ‘Change theory’ (not referenced) | N/A | N/A | N/A | N/A |
Van Gelder, Van Hees, de Roey, Monbaliu, Aerts, Coosemans et al. (2006) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Wight, Cohen, Roels and Miranda (2000) | No | No | No | N/A | None | N/A | N/A | N/A | N/A |
Efficacy of the interventions
Intervention studies with comparison groups
Authors (year); country | Purposes | Populations (n) | Interventions | Follow-up | Behavior change technique | Study methodology | Outcomes | Results |
---|---|---|---|---|---|---|---|---|
(Experimental versus Control) | ||||||||
Dettle, Sagel and Chrysler (1994); United States | To gain a better understanding of health care professionals’ experience, knowledge, attitudes, and comfort level regarding organ and tissue donation | Nurses and Chaplains (n = 343) | Educational: | 6 months | • Provide instruction | Health professionals survey | Approached family | Experimental 18% → 38% (P = .039) |
• Formal in-service on organ and tissue donation | ||||||||
Control 4% → 25% (P < .001) | ||||||||
• Unit meeting addressing donation issues | ||||||||
• Dealing with a family of an actual donor | ||||||||
Kittur, McMenamin and Knott (1990); United States | To evaluate the impact of an organ donor and tissue donor advocacy program on community hospitals | Hospital staff: physicians, nurses and administrators (n = not mentioned) | Educational: | 12 months | • Provide instruction | Not mentioned | Referred potential donor | 44 donors versus 2 donors |
• Hospital’s organ and tissue donation policies and procedures | • Provide contingent rewards | |||||||
• Teach to use prompts or cues | ||||||||
Organ and/or tissue donor recovered | 18 donors versus 1 donor | |||||||
• Sending letter of gratitude to requestors | ||||||||
• Sending letter reminding to request all eligible patients | ||||||||
Organizational: | ||||||||
• Developing a donor advocate role | ||||||||
Light (1987); United States | To evaluate the efficacy of including printed criteria and procedures with the autopsy permits as a simple, inexpensive method of increasing cornea donation | Residents (n = 84) | Educational: | 4 months | • Provide information on consequence | Eye bank data analysis | Organ and/or tissue donor recovered | Experimental 1.8% → 10.2% (P = .009) |
• Instruction for cornea donation and a checklist of donation procedures | • Provide instruction | |||||||
Control 7.1% → 8.5% (not significant) | ||||||||
Nelson, Marymont, Durand, Reyes and Davis (1992); United States | To examine the organ procurement organization’s educational activities and their effects on attitudes, knowledge, and referral behavior | Nurses, physicians and chaplains (n = 265) | Educational: | Not mentioned | • Intervention not described | Health professionals survey | Approached family | 59% versus 46% (P = .027) |
• Continuing medical education | ||||||||
• Newsletters | ||||||||
• Other publications | ||||||||
• Requestor’s workshop | ||||||||
• In-service training session | ||||||||
• Others programs | ||||||||
Referred potential donor | 46% versus 9% (P = .001) | |||||||
Riker and White (1995); United States | To evaluate physician response to an educational program to increase referral of potential organ or issue donors in an emergency department | Physicians (n = not mentioned) | Educational: | 6 months | • Provide instruction | Hospital charts review | Approached family | 65% versus 6.6% (P = .001) |
• One-hour conference on the physician’s role in requesting donation and review the criteria for donation and services available from transplant program | ||||||||
Obtained donation consent | 32% versus 6.6% (P = .08) | |||||||
Organ and/or tissue donor recovered | 48% versus 5.5% (P = .003) |
Studies | Outcomes | Risk ratio (95% CI) |
---|---|---|
Dettle et al. (1994) | Approached family | 1.53 (0.82, 2.85) |
Kittur et al. (1990) | Referred potential donor | N/A |
Organ and/or tissue donor recovered | N/A | |
Light (1987) | Organ and/or tissue donor recovered | 1.19 (0.45, 3.12) |
Nelson et al. (1992) | Approached family | 1.28 (1.01, 1.61) |
Referred potential donor | 5.04 (2.79, 9.10) | |
Riker and White (1995) | Approached family | 9.71 (1.44, 65.53) |
Obtained donation consent | 4.85 (0.69, 34.28) | |
Organ and/or tissue donor recovered | 8.67 (1.24, 60.58) |
Intervention studies without a comparison group (pre-post assessments)
Authors (year); country | Purposes | Populations (n) | Interventions | Follow-up | Behavior change technique | Study methodology | Outcomes | Results |
---|---|---|---|---|---|---|---|---|
(pre → post) | ||||||||
Alonso, Fernandez, Mataix et al. (1999); Spain | To present the results of a pilot study carried out in Seville, Spain, evaluating the donor action program | Hospital staff (n = not mentioned) | Educational: | 12 months | • Provide instruction | Medical records review | Detected potential donor | 81.0% → 97.5% |
• Training in family interview and communication | ||||||||
• Training in donor detection and brain death diagnosis | Organ and/or tissue donor recovered | 32.1% → 44.4% | ||||||
• Creating guidelines for donation process | ||||||||
Beasley, Capossela, Brigham, Gunderson and Gortmaker (1997); United States | To increase organ donation in 50 hospitals in three organ procurement organization service areas simultaneously by using a large-scale intervention | Physicians, residents, nurses, social workers, chaplains and administrators (n = not mentioned) | Educational: | 24 months | • Provide instruction | Medical records review | Approached family | 69.0% → 85.6% (P = .001) |
• Presentation of donation protocols | • Provide feedback on performance | |||||||
• Review health professional role in donation process | Referred potential donor | 55.5% → 80.2% (P = .001) | ||||||
• Department meeting | Obtained donation consent | 50.9% → 52.2% (not significant) | ||||||
• In-services | ||||||||
Organizational: | Organ and/or tissue donor recovered | 32.9% → 42.5% (P = .005) | ||||||
• Organ donation protocols | ||||||||
o Potential donor identification | ||||||||
o Notification of the organ procurement organization | ||||||||
o Ensuring decoupled request | ||||||||
o Private setting to ask for donation | ||||||||
o Active inclusion of organ procurement organization in request | ||||||||
Bleakley (2010); United Kingdom | To increase the number of donated organs through an effective donor identification and referral scheme in a large acute hospital’s critical care units | Clinical staff | Educational: | 12 months | • Intervention not described | Not mentioned | Referred potential donor | 4 → 121 (donors) |
(n = 170) | • Education program on required referral | |||||||
Organizational: | ||||||||
• Hospital policy on how to make a referral | ||||||||
Milanés, Gonzalez, Hernandez, Arminio, Clesca and Rivas-Vetencourt (2003); Venezuela | To find solutions to the critical donor shortage situation, and its negative socioeconomic impact in our society, by implementing a transplant coordination program in a hospital with a variety of departments, including neurosurgery and kidney transplantation | Healthcare staff in the critical care area (n = 97) | Educational: | 24 months | • Provide instruction | Medical records review | Detected potential donor | 8.1% → 57.5% |
• Detection, identification and donor criteria | ||||||||
• Death diagnostic | ||||||||
• Donor maintenance | Organ and/or tissue donor recovered | 1.6% → 9.1% | ||||||
• Organ and tissue viability studies | ||||||||
• Family interview, requesting consent | ||||||||
• Organ sharing, allocation and preservation | ||||||||
• Transplant ethics and legislation | ||||||||
Niday, Painter, Peak et al. (2007); United States | To implement and evaluate a scripted information about organ and tissue donation for hospice inpatient on admission | Nurses | Educational: | 6 months | • Provide instruction | Review of death records | Organ and/or tissue donor recovered (corneal rates) | 6.3% → 20.6% |
(n = 12) | • Scripted instruction to prompt nurses to introduce the subject of donation | |||||||
Organ and/or tissue donor recovered (tissue rates) | 0.0% → 0.0% | |||||||
Organizational: | ||||||||
• Give tissue donation information upon admission as part of the normal admission process and then repeated at the time of death. | ||||||||
Shafer, Durand, Hueneke, et al. (1998); United States | To determine whether donors could be produced from non-donor hospitals | Nurses and hospital staff | Educational: | 17 months | • Intervention not described | Monthly death records audit | Referred potential donor (organ) | 24 → 139 (donors) |
(n = 25 hospitals) | • Training activities | |||||||
• Education programs and materials | Referred potential donor (tissue) | 202 → 3,931 (donors) | ||||||
Organizational: | ||||||||
• Develop in-house coordinators | ||||||||
Organ donor recovered | 8 → 44 (donors) | |||||||
Tissue donor recovered | 154 → 423 (donors) | |||||||
Stark, Wikoren and Martone (1994); United States | To develop and pilot an organ donation program that focuses on the collaborative efforts of the entire health care team, hospital administration and organ procurement agency | Physicians, nurses and hospital personnel (n = not mentioned) | Educational: | 24 months | • Provide information on consequences | Not mentioned | Detected potential donor | 45.7% → 92.0% |
• Partners in organ donation program | ||||||||
o Promote positive attitudes toward donation (awareness) | • Provide instruction | Obtained donation consent | 17.1% → 56.0% | |||||
o Recognize potential donor | ||||||||
o Offering the option of donation | ||||||||
o Support the grieving of donor families | ||||||||
Organizational: | ||||||||
• Develop nurse requestor role | ||||||||
Taylor, Young and Kneteman (1997); Canada | To describe the development of a program to cross-train critical care nurses as organ procurement coordinators | Intensive care units nurses (n = not mentioned) | Educational: | Not mentioned | • Provide instruction | Not mentioned | Donation rates | 18 donors per million population → 31 donors per million population (72% increase rate) |
• Classroom instruction | ||||||||
• Preceptor clinical experience | ||||||||
Van Gelder, Van Hees, de Roey, Monbaliu, Aerts, Coosemans et al. (2006); Belgium | To measure the impact of an intervention plan designed to optimize the donor detection process and donor referral patterns | Departments of neurology, neurosurgery, anesthesiology, intensive care medicine and abdominal transplant (n = not mentioned) | Educational: | 48 months | • Provide instruction | Not mentioned | Organ and/or tissue donor recovered | 230 → 301 (donors) (P < .05) |
• Provide feedback on performance | ||||||||
• Information on donor criteria | ||||||||
• Communication between donor and transplant centers | ||||||||
Organizational: | ||||||||
• Facilitation of procedure | ||||||||
Tissue donor recovered | 66 → 180 (donors) (P < .001) | |||||||
Wight, Cohen, Roels and Miranda (2000); United Kingdom | To evaluate the immediate (6 months), short-term (1 year) and sustained (2 years) effects of the Donor Action program on donation rates in different countries | Intensive care units staff (n = not mentioned) | Educational: | 12 months (United Kingdom) | • Provide instruction | Medical records review | Organ donor recovered (United Kingdom.) | 122% increase (6 months) |
• Educational program on: | 24 months (Spain) | • Provide feedback on performance | ||||||
o Family care and communication | ||||||||
40% increase (12 months) | ||||||||
o Donor maintenance | • Prompt practice | |||||||
o Organ retrieval | ||||||||
Organizational: | ||||||||
• Forming a Donor Action committee | ||||||||
Have referred potential donor (Spain) | 16% increase (24 months) | |||||||
Organ donor recovered (Spain) | 33% increase (24 months) |