Attitudes and acceptability of organ and tissue donation registration in the emergency department: a national survey of emergency physicians.

PURPOSE: There is a worldwide shortage of organs for transplantation. One method to increase the number of organs available for transplant is to increase the number of registered organ donors. The emergency department (ED) may be a suitable venue to disseminate knowledge to patients about organ donation, and to offer an immediate or future opportunity to register as an organ donor. This study aimed to assess emergency physicians' attitudes and acceptability of an ED-based organ donation registration initiative. METHODS: We developed and distributed a national postal survey using a modified Dillman's tailored design technique to a random sample of emergency physicians selected from the Canadian Medical Directory. RESULTS: From a total of 474 delivered surveys, we received 228 responses (48.1%). 98.5% of emergency physicians support the concept of deceased organ donation. 85.1% felt that the emergency department is an appropriate setting to disseminate information regarding organ donation and 77.6% felt that it is an appropriate location to offer an immediate opportunity to register as an organ donor. 74.1% of physicians who responded report to be personally registered as an organ donor. CONCLUSION: Most emergency physicians are supportive of organ donation promotion in the ED, including offering an immediate opportunity to register.

RéSUMé: OBJECTIF: Il y a une pénurie mondiale d'organes destinés à la transplantation. Une méthode pour augmenter le nombre d'organes disponibles pour la transplantation est d'augmenter le nombre de donneurs d'organes enregistrés. Le service des urgences (SU) peut être un lieu approprié pour informer les patients sur le don d'organes et leur offrir la possibilité, immédiate ou future, de s'inscrire comme donneur d'organes. Cette étude visait à évaluer les attitudes des médecins urgentistes et l'acceptabilité d'une initiative d'enregistrement des dons d'organes aux urgences. MéTHODES: Nous avons élaboré et distribué une enquête postale nationale en utilisant une technique modifiée de conception sur mesure de Dillman à un échantillon aléatoire de médecins urgentistes sélectionnés à partir de l'annuaire médical canadien. RéSULTATS: Sur un total de 474 questionnaires remis, nous avons reçu 228 réponses (48,1%). 98,5 % des médecins urgentistes soutiennent le concept du don d'organes de personnes décédées. 85,1 % ont estimé que le service des urgences est un lieu approprié pour diffuser des informations sur le don d'organes et 77,6 % ont estimé que c'est un lieu approprié pour offrir une possibilité immédiate de s'inscrire comme donneur d'organes. 74,1 % des médecins qui ont répondu déclarent être personnellement inscrits comme donneurs d'organes. CONCLUSION: La plupart des médecins urgentistes sont favorables à la promotion du don d'organes dans les urgences, notamment en offrant la possibilité de s'inscrire immédiatement.

Effect of prenotification on the response rate of a postal survey of emergency physicians: a randomised, controlled, assessor-blind trial.

OBJECTIVES: Response rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey of emergency physicians. DESIGN: This was a substudy of a national, cross-sectional postal survey sent to emergency physicians in Canada. We randomised participants to either receive a postal prenotification letter prior to the survey, or to no prenotification letter. PARTICIPANTS: A random sample of 500 emergency physicians in Canada. Participants were selected from the Canadian Medical Directory, a national medical directory which lists more than 99% of practising physicians in Canada. INTERVENTIONS: Using computer-generated randomisation, physicians were randomised in a concealed fashion to receive a prenotification letter approximately 1 week prior to the survey, or to not receive a prenotification letter. All physicians received an unconditional incentive of a $3 coffee card with the survey instrument. In both groups, non-respondents were sent reminder surveys approximately every 14 days and a special contact using Xpresspost during the final contact attempt. OUTCOME: The primary outcome was the survey response rate. RESULTS: 201 of 447 eligible physicians returned the survey (45.0%). Of 231 eligible physicians contacted in the prenotification group, 80 (34.6%) returned the survey and among 237 eligible physicians contacted in the no-prenotification group, 121 (51.1%) returned the survey (absolute difference in proportions 16.5%, 95% CI 2.5 to 30.5, p=0.01). CONCLUSION: Inclusion of a prenotification letter resulted in a lower response rate in this postal survey of emergency physicians. Given the added costs, time and effort required to send a prenotification letter, this study suggests that it may be more effective to omit the prenotification letter in physician postal surveys.

Case Discussions in Advanced Care Planning.

BACKGROUND: Advanced care planning (ACP) provides an opportunity for individuals to explore and document their values concerning medical care decisions prior to an acute event. This manuscript explores the value of ACP and compares and contrasts 2 ACP models currently in practice. METHODS: This hypothetical case describes an elderly, frail patient with end-stage chronic obstructive pulmonary disease who is also a high user of health care resources. A new palliative care-led outpatient ACP clinic model is described using this example. RESULTS: Using the ACP clinic model in this case reveals how different a patient's end of life experience may be when proper, proactive planning measures are in place. With proper education and discussion around this patient and family's wishes pertaining to the end of his life, this man was able to change his plan of care from aggressive resuscitation treatment in hospital to a peaceful palliative experience at home. CONCLUSIONS: In this case description, the valuable role of ACP in preserving quality of life for patients, increasing satisfaction with care, and decreasing distress among family members during a medical event is demonstrated.