Death determination by neurologic criteria-what do families understand?

被引:0
|
作者
Sarti, Aimee [1 ,2 ]
Sutherland, Stephanie [1 ]
Meade, Maureen [3 ]
Hornby, Laura C. [4 ]
Wilson, Lindsay [4 ]
Landriault, Angele [5 ]
Vanderspank-Wright, Brandi [2 ,6 ]
Valiani, Sabira [7 ]
Keenan, Sean J. [8 ,9 ]
Weiss, Matthew [10 ]
Werestiuk, Kim [11 ]
Beed, Stephen H. [12 ]
Kramer, Andreas [13 ]
Kawchuk, Joann [7 ]
Cardinal, Pierre [1 ]
Dhanani, Sonny [14 ]
Lotherington, Ken [4 ]
Pagliarello, Giuseppe [1 ]
Chasse, Michael [15 ]
Gatien, Mary [16 ]
Parsons, Kim A. [17 ]
Chandler, Jennifer [18 ]
Nickerson, Peter [19 ]
Shemie, Same [4 ,20 ]
机构
[1] Ottawa Hosp, Dept Crit Care, Gen Campus, Ottawa, ON K1H 8L6, Canada
[2] Ottawa Hosp Res Inst, Ottawa, ON, Canada
[3] Hamilton Hlth Sci, Dept Crit Care, Hamilton, ON, Canada
[4] Canadian Blood Serv, Ottawa, ON, Canada
[5] Royal Coll Phys & Surg Canada, Practice Performance & Innovat Unit, Ottawa, ON, Canada
[6] Univ Ottawa, Fac Hlth Sci, Sch Nursing, Ottawa, ON, Canada
[7] Saskatchewan Hlth Author, Dept Adult Crit Care, Saskatoon, SK, Canada
[8] BC Transplant, Vancouver, BC, Canada
[9] Univ British Columbia, Dept Med, Div Crit Care, Vancouver, BC, Canada
[10] Transplant Quebec, Montreal, PQ, Canada
[11] Transplant Manitoba, Winnipeg, MB, Canada
[12] Dalhousie Univ, Fac Med, Dept Crit Care, Halifax, NS, Canada
[13] Univ Calgary & Southern Alberta, Dept Clin Neurosci, Organ & Tissue Donat Program, Calgary, AB, Canada
[14] Childrens Hosp Eastern Ontario, Div Crit Care, Ottawa, ON, Canada
[15] Ctr Hosp Univ Montreal, Dept Med, Montreal, PQ, Canada
[16] Horizon Hlth Network, Miramichi, NB, Canada
[17] Organ Procurement & Exchange Newfoundland & Labra, St John, NF, Canada
[18] Univ Ottawa, Fac Law, Common Law Sect, Ottawa, ON, Canada
[19] Univ Manitoba, Fac Hlth Sci, Winnipeg, MB, Canada
[20] McGill Univ, Dept Pediat, Div Crit Care, Montreal, PQ, Canada
关键词
bereaved family members; brain death; brain death determination; death determination by neurologic criteria; qualitative; BRAIN-DEATH; ORGAN DONATION; KNOWLEDGE; RELATIVES; MEMBERS; CARE;
D O I
10.1007/s12630-023-02416-3
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
PurposeCurrently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members' (FMs') understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs).MethodsWe conducted a qualitative study using semistructured, in-depth interviews with FMs who were asked to make an organ donation decision on behalf of adult or pediatric patients with death determination by neurologic criteria (DNC) in Canadian ICUs.ResultsFrom interviews with 179 FMs, six main themes emerged: 1) state of mind, 2) communication, 3) DNC may be counterintuitive, 4) preparation for the DNC clinical assessment, 5) DNC clinical assessment, and 6) time of death. Recommendations on how clinicians can help FMs to understand and accept DNC through communication at key moments were described including preparing FMs for death determination, allowing FMs to be present, and explaining the legal time of death, combined with multimodal strategies. For many FMs, understanding of DNC unfolded over time, facilitated with repeated encounters and explanation, rather than during a single meeting.ConclusionFamily members' understanding of brain death and death determination represented a journey that they reported in sequential meeting with health care providers, most notably physicians. Modifiable factors to improve communication and bereavement outcomes during DNC include attention to the state of mind of the family, pacing and repeating discussions according to families' expressed understanding, and preparing and inviting families to be present for the clinical determination including apnea testing. We have provided family-generated recommendations that are pragmatic and can be easily implemented.
引用
收藏
页码:637 / 650
页数:14
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