Development of a scale to measure African American attitudes toward organ donation

Feeling better on hemodialysis: user-centered design requirements for promoting patient involvement in the prevention of treatment complications

OBJECTIVE

Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention.

METHODS

We conducted observations (156 hours) and interviews (n = 28) with patients in 3 hemodialysis clinics, followed by 9 focus groups (including participatory design activities) with patients (n = 17). Inductive and deductive analyses resulted in themes and design principles linked to constructs from social, cognitive, and self-determination theories.

RESULTS

Hemodialysis patients want an informatics intervention for IDH prevention that collapses distance between patients, peers, and family; harnesses patients' strength of character and resolve in all parts of their life; respects and supports patients' individual needs, preferences, and choices; and links "feeling better on dialysis" to becoming more involved in IDH prevention. Related design principles included designing for: depth of interpersonal connections; positivity; individual choice and initiative; and comprehension of connections and possible actions.

DISCUSSION

Findings advance the design of informatics interventions by presenting design requirements for outpatient safety and addressing key design opportunities for informatics to support patient involvement; these include incorporation of behavior change theories. Results also demonstrate the meaning of design choices for hemodialysis patients in the context of their experiences; this may have applicability to other populations with serious illnesses.

CONCLUSION

The resulting patient-facing informatics intervention will be evaluated in a pragmatic cluster-randomized controlled trial in 28 hemodialysis facilities in 4 US regions.

Examination of Racial and Ethnic Differences in Deceased Organ Donation Ratio Over Time in the US

Importance

Historically, deceased organ donation was lower among Black compared with White populations, motivating efforts to reduce racial disparities. The overarching effect of these efforts in Black and other racial/ethnic groups remains unclear.

Objective

To examine changes in deceased organ donation over time.

Design, Setting, and Participants

This population-based cohort study used data from January 1, 1999, through December 31, 2017, from the Scientific Registry of Transplant Recipients to quantify the number of actual deceased organ donors, and from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Detailed Mortality File to quantify the number of potential donors (individuals who died under conditions consistent with organ donation). Data were analyzed from December 2, 2019, to May 14, 2020.

Exposures

Race and ethnicity of deceased and potential donors.

Main Outcomes and Measures

For each racial/ethnic group and year, a donation ratio was calculated as the number of actual deceased donors divided by the number of potential donors. Direct age and sex standardization was used to allow for group comparisons, and Poisson regression was used to quantify changes in donation ratio over time.

Results

A total of 141 534 deceased donors and 5 268 200 potential donors were included in the analysis. Among Black individuals, the donation ratio increased 2.58-fold from 1999 to 2017 (yearly change in adjusted incidence rate ratio [aIRR], 1.05; 95% CI, 1.05-1.05; P < .001). This increase was significantly greater than the 1.60-fold increase seen in White individuals. Nevertheless, substantial racial differences remained, with Black individuals still donating at only 69% the rate of White individuals in 2017 (P < .001). Among other racial minority populations, changes were less drastic. Deceased organ donation increased 1.80-fold among American Indian/Alaska Native and 1.40-fold among Asian or Pacific Islander populations, with substantial racial differences remaining in 2017 (American Indian/Alaska Native population donation at 28% and Asian/Pacific Islander population donation at 85% the rate of the White population). Deceased organ donation differences between Hispanic/Latino and non-Hispanic/Latino populations increased over time (4% lower in 2017).

Conclusions and Relevance

The findings of this cohort study suggest that differences in deceased organ donation between White and some racial minority populations have attenuated over time. The greatest gains were observed among Black individuals, who have been the primary targets of study and intervention. Despite improvements, substantial differences remain, suggesting that novel approaches are needed to understand and address relatively lower rates of deceased organ donation among all racial minorities.

A Clustered Randomized Trial Informing Patients on Dialysis About Their Ability to Donate Organs and Tissues

INTRODUCTION

The transplant waiting list exceeds the number of organs available. One means of increasing the organ pool is to broaden potential donors to include those with chronic diseases.

RESEARCH QUESTIONS

The study tested the effectiveness of using peer mentors to encourage individuals on dialysis to enroll on an organ donor registry.

DESIGN

Dialysis units were pair-matched by size and racial composition and then randomized to one of 2 interventions: meetings with a peer mentor (experimental intervention) or organ donation mailings (control). Peer mentors were trained to discuss organ donation with individuals on dialysis during in-person meetings at dialysis units. The primary outcome was verified registration in the state's donor registry.

RESULTS

After adjusting for age, gender, race, income, and education and accounting for correlation within the dialysis center, there was a significant intervention effect. Among individuals in the intervention group, the odds of enrolling (verified) on the donor registry were 2.52 times higher than those in the control group.

DISCUSSION

The use of peer mentors to discuss donating organs after death with individuals on dialysis can increase enrollment on a donor registry. Dispelling myths about chronic illness and donation can counter widely held misconceptions and help persons make an informed choice about end-of-life decisions and present an opportunity to increase the number of organs and tissues available for transplant.

A quantitative appraisal of African Americans' decisions to become registered organ donors at the driver's license office

African American (AA) organ donation registration rates fall short of national objectives. The goal of the present study was to utilize data acquired from a quantitative telephone survey to provide information for a future Department of Motorized Vehicles (DMV) intervention to increase AA organ donor registration at the DMV. AAs (n = 20 177) that had visited an Alabama DMV office within a 3-month period were recruited via direct mailing to participate in a quantitative phone survey. Data from 155 respondents that participated in the survey were analyzed. Of those respondents deciding to become a registered organ donor (ROD; n = 122), one-third made that decision at the time of visiting the DMV. Of those who chose not to become a ROD (n = 33), one-third made the decision during the DMV visit. Almost 85% of all participants wanted to learn more about organ donation while waiting at the DMV, preferably via TV messaging (digital signage), with the messaging delivered from organ donors, transplant recipients, and healthcare experts. Altruism, accurate organ donation information, and encouragement from family and friends were the most important educational topics to support AAs becoming a ROD. These data provide a platform to inform future interventions designed to increase AAs becoming a ROD at the DMV.

Organ Donation Attitudes Among Individuals With Stage 5 Chronic Kidney Disease

Background

The need for transplantable organs drastically outweighs the supply. Misconceptions are a barrier to increasing the rate of donor registration. Individuals with stage 5 chronic kidney disease (CKD) may incorrectly believe they are unable to be donors; however, their attitudes have not been studied. This study aims to explore beliefs of individuals with stage 5 CKD about their ability to donate and test the validity of an organ donation scale.

Methods

We examined the psychometric properties of a new 25-item organ donation scale among 554 patients with stage 5 CKD at 12 dialysis units in southeast Michigan. Patients completed surveys during dialysis treatment with assistance from a program coordinator or social worker.

Results

Two subscales with good psychometric properties were identified: general benefits (α = 0.86) and general barriers (α = 0.80). For both subscales, more positive attitudes were associated with higher intent to sign up on the donor registry, suggesting validity of the scale.

Conclusions

Patients who were older than 60 years, white, or of higher education status reported more positive attitudes. Misconceptions about the ability of patients with stage 5 CKD to donate are common and highlight a need for education about donor eligibility. Individuals with stage 5 CKD may be able to donate organs and tissues.

Understanding the pros and cons of organ donation decision-making: Decisional balance and expressing donation intentions among African Americans

Increasing public commitment to organ donation is critical to improving donor kidney availability for end-stage renal disease patients desiring transplant. This study surveyed ( N = 1339) African Americans, measuring perceived pros relative to cons of organ donation, to evaluate an existing Transtheoretical Model decisional balance scale and associations between decisional balance and expressing donation intentions. Findings supported the existing scale structure. More positive decisional balance ratios were associated with 1.76 times the odds of expressing intentions (95% confidence interval = 1.52–2.04). Pros were more strongly linked to donation intentions than cons. Greater understanding of organ donation decision-making is valuable for informing interventions that encourage donation.

Validation of a Survey Questionnaire on Organ Donation: An Arabic World Scenario

OBJECTIVE

To validate a questionnaire for measuring factors influencing organ donation and transplant.

METHODS

The constructed questionnaire was based on the theory of planned behavior by Ajzen Icek and had 45 questions including general inquiry and demographic information. Four experts on the topic, Arabic culture, and the Arabic and English languages established content validity through review. It was quantified by content validity index (CVI). Construct validity was established by principal component analysis (PCA), whereas internal consistency was checked by Cronbach's Alpha and intraclass correlation coefficient (ICC). Statistical analysis was performed by SPSS 22.0 statistical package.

RESULTS

Content validity in the form of S-CVI/Average and S-CVI/UA was 0.95 and 0.82, respectively, suggesting adequate relevance content of the questionnaire. Factor analysis indicated that the construct validity for each domain (knowledge, attitudes, beliefs, and intention) was 65%, 71%, 77%, and 70%, respectively. Cronbach's Alpha and ICC coefficients were 0.90, 0.67, 0.75, and 0.74 and 0.82, 0.58, 0.61, and 0.74, respectively, for the domains.

CONCLUSION

The questionnaire consists of 39 items on knowledge, attitudes, beliefs, and intention domains which is valid and reliable tool to use for organ donation and transplant survey.

Peer Leaders Increase Organ Donor Designation Among Members of Historically African American Fraternities and Sororities

Introduction:

Health education programs can positively impact organ donor designation among African Americans, a disproportionately represented group on the transplant waiting list. Alumni chapters of historically African American sororities and fraternities are a novel setting for organ donation education and research.

Research Questions:

This study tested the effectiveness of a lay health advisor model to increase donor designation registrations on the Michigan Organ Donor Registry among members of Midwest alumni chapters. The secondary outcome was change in attitudes toward donation assessed by pre–post questionnaire.

Design:

Sorority/fraternity members were trained to deliver educational presentations during a 12-month period. Follow-up messaging consisted of tailored newsletters and e-mails. A cluster randomized design was utilized with 25 chapters (16 sororities and 9 fraternities) assigned to intervention (organ donation) or comparison (chronic disease).

Results:

Odds of signing up for the donor registry were 1.45 times higher for the intervention group than the comparison group. Among those identified as nondonors at baseline, the odds of signing up were 1.58 times higher for intervention than comparison.

Discussion:

Using lay health advisors in African American sororities and fraternities can increase enrollment in a donor registry. Alumni chapters offer a unique and viable setting for organ donation education and research; relationship building with chapter officials is key to success.

'If you are empathetic you care about both animals and people. I am a nurse and I don't like to see suffering anywhere': Findings from 103 healthcare professionals on attitudes to animal experimentation

This report presents qualitative and quantitative data from 103 UK healthcare professionals describing attitudes to the current system of animal testing (to produce medicines and health interventions). To gather qualitative testimony, these healthcare professionals were organised into six separate focus groups (of 18, 17, 17, 15, 17 and 19 participants) where they were asked 'what is your opinion about the current system of animal testing?' The study focussed on attitudes to the current system rather than attitudes to animal testing in general. The healthcare professionals also completed a quantitative attitude scale questionnaire consisting of 20 statements (all favourable) towards the system of animal testing as currently practised. Statements such as 'Testing agencies abide by legislation to safeguard animal welfare' were displayed and the healthcare professionals were invited to agree or disagree with these statements. The results from both the quantitative and qualitative data suggest that healthcare professionals were opposed to the current system of animal experimentation.

How Organ Donors are Different from Non-donors: Responsibility, Barriers, and Religious Involvement

To see if religious involvement, previously linked to various health behaviors, was linked to organ donation, 143 ethnically diverse undergraduates stated whether they were registered donors (53% were), and completed measures of organ donation attitudes and religious involvement. Compared with non-donors, donors reported fewer barriers, more family responsibility, and more willingness to receive donor organs, but were not different in religious involvement. Even in 2014, when being a "good Samaritan" by agreeing to organ donation is as easy as checking one box on a driver's license application, religious involvement does not seem to be a factor in checking this box.

When do next-of-kin opt-in? Anticipated regret, affective attitudes and donating deceased family member's organs

This research assessed whether affective factors promote and prevent family members from donating their loved one's organs. Participants (N = 191) imagined that a family member had died and that they had to decide whether or not to donate their organs and body parts for transplantation purposes. The least organs and body parts were donated when the deceased opposed donation. Moreover, participants who were not registered organ donors donated fewer organs than registered donors. This effect was mediated by anticipated regret, disgust and the perceived benefits of donation. Organ donation campaigns should target such factors to increase donor rates.