Background: Discussions with relatives are relevant and crucial aspects of the organ donation process and contribute to a consolidated and sustainable decision by the families of the deceased. Despite the great importance of family care, there is no systematic analysis of the quality of this communication, in contrast to the diagnosis of irreversible loss of brain function, organ retrieval and organ transplantation. For this reason, organ donation experts were interviewed about recurring characteristics of communication with relatives of the deceased. The aim of this qualitative study was to define criteria for the assessment of the structure and quality of the communication process with relatives for internal quality management in Germany.
Methods: Based on a systematic literature review and with the help of the 5‑stage S2PS2 (system for creating a questionnaire) procedure according to Kruse, interview guidelines were initially developed. As a second step, in guideline-based interviews 10 experienced organ donation experts were questioned about structural, procedural and ethical aspects of their discussions with relatives. Following the interviews, a software-based qualitative content analysis was carried out with a combined inductive-deductive category system. Finally, the first quality assurance measures for the interviews with relatives were developed in a multistep process, closely following the methodological principles V1.1 of the Institute for Quality Assurance and Transparency in Health Care (IQTIG). The individual research steps were accompanied by an expert group consisting of physicians, nurses, theologians and ethicists utilizing an anonymous Delphi procedure.
Results: In the qualitative content analysis, 5 main categories with 30 subcategories on quality relevant aspects could be identified (including, standardization and technique of conversation, interview framework and context factors, professional expertise of the interviewers, wishes of the organ donation experts). On this basis, 6 criteria for the structural quality and 7 criteria for the process quality of the discussions with relatives were formulated and summarized in a respective quality bundle. These criteria address, among other things, interprofessional communication, structured training concepts, regular further training of all team members, use of standardized communication and counselling strategies as well as documented preliminary meetings and debriefings, including supervising elements. They emphasize interdisciplinary professionalism and process management in a protected environment as well as quality assured communication and documentation. Recommendations were made for expanding the existing documentation for the organ donation process and for documenting the preliminary meetings and debriefings.
Conclusion: Recurring communication and process characteristics as well as requirements for the members of the treatment team who conduct the conversation can be identified for the interviews with relatives, which show potential for improvement to various degrees. This justifies the structured derivation of a quality bundle for the structural and process quality family care related to organ donation, which should enable a low-threshold entry into an institution internal systematic quality assessment of communication with relatives in Germany. Due to the different legal, medical and social specifics in an international context, the study results cannot be directly transferred to other countries.
Zusammenfassung: HINTERGRUND: Die Angehörigengespräche stellen einen relevanten Teilaspekt des Organspendeprozesses dar und tragen maßgeblich zu einer gefestigten und dauerhaft tragfähigen Entscheidung der Familien der Verstorbenen bei. Trotz dieser großen Bedeutung der Angehörigengespräche existiert hierzu keine systematische Betrachtung der Versorgungsqualität. Aus diesem Grund werden Transplantationsbeauftragte zu wiederkehrenden Merkmalen der Angehörigengespräche befragt. Die vorliegende qualitative Untersuchung verfolgt das Ziel, Kriterien zur Struktur- und Prozessqualität der Angehörigengespräche für ein einrichtungsinternes Qualitätsmanagement in Deutschland abzuleiten.
Methode: In teilstrukturierten Interviews werden 10 erfahrene Transplantationsbeauftragte zu strukturellen, prozessualen und ethischen Aspekten der Angehörigengespräche befragt. Im Anschluss daran erfolgt eine qualitative Inhaltsanalyse. Die einzelnen Forschungsschritte werden durch eine Fachgruppe in einem Delphi-Verfahren begleitet.
Ergebnisse: In der qualitativen Inhaltsanalyse können 5 Haupt- und 30 Subkategorien zu qualitätsrelevanten Aspekten identifiziert und auf dieser Basis 6 Kriterien zur Strukturqualität und 7 Kriterien zur Prozessqualität der Angehörigengespräche formuliert werden. Diese Kriterien adressieren u. a. eine interprofessionelle Gesprächsführung, strukturierte Einarbeitungskonzepte sowie dokumentierte Vor- und Nachbesprechungen.
Schlussfolgerung: Die Angehörigengespräche im Kontext der Organspende weisen trotz einzelfallspezifischer Besonderheiten grundsätzliche Qualitätsaspekte auf, zu denen erkennbare Verbesserungspotenziale bestehen. Die beschriebenen Struktur- und Prozesskriterien können das einrichtungsinterne Qualitätsmanagement unterstützen und dazu beitragen, die Versorgungsprozesse fortlaufend zu verbessern.
Keywords: Communication; Family care; Interprofessional; Quality indicators; Tissue and organ procurement.
© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.