title: Intensive care staff, the donation request and relatives' satisfaction with the decision: a focus group study.
abstract: BACKGROUND
  Effectiveness of the donation request is generally measured by consent rates, rather than by relatives' satisfaction with their decision. Our aim was to elicit Dutch ICU staffs' views and experiences with the donation request, to investigate their awareness of (dis)satisfaction with donation decisions by relatives, specifically in the case of refusal, and to collect advice that may leave more relatives satisfied with their decision.
  
  
  METHODS
  Five focus groups with a total of 32 participants (IC physicians, IC nurses and transplant coordinators) from five university hospitals in the Netherlands. Transcripts were examined using standard qualitative methods.
  
  
  RESULTS
  Four themes (donation request perceived by ICU staff from the perspective of relatives; donation request perceived by ICU staff from their own perspective; aftercare; donation in society) divided into 14 categories were identified. According to ICU staff, relatives mentioned their own values more frequently than values of the potential donor as important for the decision. ICU staff observed this imbalance, but reacted empathically to the relatives' point of view. ICU staff rarely suggested reconsideration of refusal and did not ask relatives for arguments. ICU staff did not always feel comfortable with a request in the delicate context of brain death. Sometimes the interests of patient, relatives and those on the waiting list were irreconcilable. ICU staff were mostly unaware of relatives' regret following their decisions. Aftercare did not provide this type of information. Donation request by IC physicians was influenced by the way organ donation has been regulated in society (law, donor register, education, media).
  
  
  CONCLUSIONS
  Our findings lead to the hypothesis that giving relatives more time and inviting them to reconsider their initial refusal will lead to a more stable decision and possibly more consent.
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands ; Department of Spiritual and Pastoral Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Jack
authors: J
authors: de Groot
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands ; Kalorama Foundation, Nijmegen, the Netherlands.
authors: Myrra
authors: M
authors: Vernooij-Dassen
authors: Department of Spiritual and Pastoral Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Anneke
authors: A
authors: de Vries
authors: Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Cornelia
authors: C
authors: Hoedemaekers
authors: Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Andries
authors: A
authors: Hoitsma
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands ; Department of Spiritual and Pastoral Care, Radboud University Medical Center, Nijmegen, the Netherlands ; Department of Religious Studies and Theology, Faculty of Humanities, Utrecht University, Utrecht, the Netherlands.
authors: Wim
authors: W
authors: Smeets
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Evert
authors: E
authors: van Leeuwen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D004644:Emotions; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands; D010549:Personal Satisfaction; D013997:Time Factors; D009927:Tissue and Organ Procurement
keywords: Donation request; Health care professionals; Organ donation; Qualitative research; Regret