Publication: Análisis de las actitudes y los conocimientos de los profesionales sanitarios sobre la donación en asistolia controlada en la Comunidad Autónoma de Aragón
Authors
Jimeno Griñó, Carmen
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Escuela Internacional de Doctorado
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Febrero Sánchez, Beatriz ; Ramírez, Pablo (Ramírez Romero)
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Introducción: Aunque España lidera la donación y el trasplante, la disponibilidad de órganos continúa siendo insuficiente para cubrir la demanda. La donación en asistolia controlada (DAC), aplicada tras la decisión de limitación de tratamientos de soporte vital (LTSV), se ha consolidado como una de las principales estrategias para aumentar el número de donantes, respaldada por criterios técnicos, legales y éticos. Su implementación efectiva exige conocimientos adecuados y actitudes favorables por parte de los profesionales sanitarios. Objetivos: 1) Analizar las actitudes y los conocimientos de los profesionales sanitarios hacia la DAC, el Documento de Voluntades Anticipadas (DVA) y la LTSV, 2) Determinar las variables psicosociales y el perfil asociado a la actitud favorable hacia la DAC. Material y métodos: Estudio observacional, transversal y multicéntrico, mediante cuestionario anónimo, autoadministrado y voluntario a profesionales (médicos, enfermería y técnicos en cuidados auxiliares de enfermería [TCAE]) de Medicina Intensiva, Medicina Interna, Neurología y Urgencias de hospitales de Aragón (enero-marzo de 2019). Variable principal: la actitud hacia la DAC; covariables: psicosociales y de conocimiento (DVA, LTSV). Análisis descriptivo, bivariante (X2/Fisher; U de Mann-Whitney) y multivariable (regresión logística binaria), p < 0,05; SPSS 29. Ética: aprobado por el Comité de Ética de la Investigación de la Comunidad Autónoma de Aragón. Resultados: Respondieron 628 profesionales (48 %). Tasa de respuesta por servicio: Neurología 64 %, Medicina Interna 57 %, Urgencias 44 % y Medicina Intensiva 37 %. Por categoría profesional: médicos 54 %, enfermería 49 % y TCAE 42 %. Por provincia: Teruel 74 %, Huesca 72 % y Zaragoza 37 %. La actitud hacia la DAC fue favorable en el 40 %, indecisa en el 59 % y contraria en el 1 %. El 65 % desconoce el concepto de DAC. La actitud favorable hacia el DVA fue alta (media 7,8 ± 2,8); el 97 % conoce su existencia, aunque el 63 % no ha accedido al Registro ni sabría hacerlo. La actitud hacia la LTSV fue ligeramente favorable (media 8,4 ± 2,1); aunque el 68 % conoce el término, el 45 % presenta un conocimiento incorrecto. En el análisis bivariante una actitud más favorable se asoció con: factores profesionales (perfil médico/Zaragoza/Medicina Intensiva/entornos generador-trasplantador); de información y formación sobre donación y trasplante de órganos (DTO); sociales (conversaciones y apoyo del entorno); actitud personal favorable (donación propia y la de un familiar) y de conocimiento/experiencia (DVA, LTSV y DAC) (p < 0,05). En el análisis multivariable permanecieron como predictores independientes de actitud favorable: trabajar en Medicina Intensiva (OR 1,98; IC95 % 1,17-3,36), actividad laboral vinculada al trasplante (OR 1,93; IC95 % 1,19-3,11), conversar sobre DTO en el entorno sociofamiliar (OR 1,80; IC95 % 1,10-2,95), actitud favorable hacia la donación propia (OR 1,83; IC95 % 1,22-2,76), conocer la regulación legal de la LTSV (OR 1,74; IC95 % 1,09-2,81), saber que la LTSV es una práctica frecuente en la UCI (OR 2,10; IC95 % 1,37-3,17), conocer correctamente el concepto de DAC (OR 2,82; IC95 % 1,59-4,99) y tener predisposición a desarrollar programas de DAC (OR 1,14; IC95 % 1,02-1,27). Conclusiones: En un ámbito multicéntrico, con servicios clínicos de exposición heterogénea a la DAC, la actitud favorable fue baja, con un alto porcentaje de indecisos. Se identificaron áreas de mejora conceptual, pese a una elevada predisposición a mejorar la formación. El perfil favorable se asoció con el entorno profesional (Medicina Intensiva/trasplante), el apoyo y la interacción social y un mayor conocimiento específico (DAC/LTSV). Estos hallazgos respaldan la implementación de estrategias formativas específicas para disminuir la indecisión y facilitar el desarrollo de la DAC, lo que podría contribuir a incrementar las tasas de donación y aliviar las listas de espera para trasplante.
Introduction: Although Spain leads in organ donation and transplantation, organ availability remains insufficient to meet demand. Controlled donation after circulatory death (cDCD), implemented following a limitation of life-sustaining treatments (LLST) decision, has become one of the principal strategies to increase donor numbers and is supported by technical, legal, and ethical standards. Effective implementation requires adequate knowledge and favorable attitudes among healthcare professionals. Objectives: 1) To analyze healthcare professionals' attitudes and knowledge regarding cDCD, Advance Directives (AD), and LLST, 2) To determine the psychosocial variables and the profile associated with a favorable attitude toward cDCD. Materials and methods: Observational, cross-sectional, multicenter study using an anonymous, self-administered, voluntary questionnaire among professionals (physicians, nurses, and auxiliary nursing care technicians [TCAE]) from the Intensive Care, Internal Medicine, Neurology, and Emergency departments of hospitals in Aragon (January-March 2019). Primary variable: the attitude toward cDCD. Covariates: psychosocial and knowledge variables (AD, LLST). Descriptive analysis; bivariate tests (chi-square/Fisher's exact; Mann-Whitney U) and multivariable analysis (binary logistic regression), p < 0.05; SPSS v29. Ethics: approved by the Research Ethics Committee of the Autonomous Community of Aragon. Results: A total of 628 professionals responded (48%). Response rate by service: Neurology 64%, Internal Medicine 57%, Emergency 44%, Intensive Care 37%. By professional category: physicians 54%, nursing 49%, TCAE 42%. By province: Teruel 74%, Huesca 72%, Zaragoza 37%. Attitude toward cDCD was favorable in 40%, undecided in 59%, and unfavorable in 1%. 65% were unfamiliar with the cDCD concept. Attitude toward AD was high (mean 7.8 ± 2.8); 97% knew of its existence, although 63% had not accessed the Advance Directives Registry and would not know how to do so. Attitude toward LLST wasslightly favorable (mean 8.4 ± 2.1); although 68% knew the term, 45% showed incorrect knowledge. In the bivariate analysis, a more favorable attitude was associated with: professional/clinical setting factors (medical profile/Zaragoza/Intensive Care/donor- generating and transplant-performing centers); information/education on organ donation and transplantation; social factors (conversations and support within the social environment); personal attitude (willingness to donate one's own organs and those of a relative); and knowledge/experience (AD, LLST, and cDCD) (p < 0.05). In the multivariable model, independent predictors of a favorable attitude were: working in Intensive Care (OR 1.98; IC95 % 1.17-3.36), professional activity linked to transplantation (OR 1.93; IC95 % 1.19-3.11), discussing organ donation and transplantation within the family/social environment (OR 1.80; IC95 % 1.10-2.95), favorable attitude toward donating one's own organs (OR 1.83; IC95 % 1.22-2.76), knowledge of LLST's legal regulation (OR 1.74; IC95 % 1.09-2.81), awareness that LLST is common practice in ICUs (OR 2.10; IC95 % 1.37-3.17), correct understanding of the cDCD concept (OR 2.82; IC95 % 1.59-4.99), and willingness to develop cDCD programs (OR 1.14; IC95 % 1.02-1.27).Conclusions: In a multicenter setting with clinical services heterogeneously exposed to cDCD, the proportion with a favorable attitude was low, with a high proportion of undecided respondents. Conceptual gaps were identified despite a high willingness to receive training. The favorable profile was associated with the professional environment (Intensive Care/transplantation), social support and interaction, and greater specific knowledge (cDCD/LLST). These findings support implementing targeted training strategies to reduce indecision and facilitate cDCD program development, which could, in turn, help increasedonation rates and alleviate transplant waiting lists.
Introduction: Although Spain leads in organ donation and transplantation, organ availability remains insufficient to meet demand. Controlled donation after circulatory death (cDCD), implemented following a limitation of life-sustaining treatments (LLST) decision, has become one of the principal strategies to increase donor numbers and is supported by technical, legal, and ethical standards. Effective implementation requires adequate knowledge and favorable attitudes among healthcare professionals. Objectives: 1) To analyze healthcare professionals' attitudes and knowledge regarding cDCD, Advance Directives (AD), and LLST, 2) To determine the psychosocial variables and the profile associated with a favorable attitude toward cDCD. Materials and methods: Observational, cross-sectional, multicenter study using an anonymous, self-administered, voluntary questionnaire among professionals (physicians, nurses, and auxiliary nursing care technicians [TCAE]) from the Intensive Care, Internal Medicine, Neurology, and Emergency departments of hospitals in Aragon (January-March 2019). Primary variable: the attitude toward cDCD. Covariates: psychosocial and knowledge variables (AD, LLST). Descriptive analysis; bivariate tests (chi-square/Fisher's exact; Mann-Whitney U) and multivariable analysis (binary logistic regression), p < 0.05; SPSS v29. Ethics: approved by the Research Ethics Committee of the Autonomous Community of Aragon. Results: A total of 628 professionals responded (48%). Response rate by service: Neurology 64%, Internal Medicine 57%, Emergency 44%, Intensive Care 37%. By professional category: physicians 54%, nursing 49%, TCAE 42%. By province: Teruel 74%, Huesca 72%, Zaragoza 37%. Attitude toward cDCD was favorable in 40%, undecided in 59%, and unfavorable in 1%. 65% were unfamiliar with the cDCD concept. Attitude toward AD was high (mean 7.8 ± 2.8); 97% knew of its existence, although 63% had not accessed the Advance Directives Registry and would not know how to do so. Attitude toward LLST wasslightly favorable (mean 8.4 ± 2.1); although 68% knew the term, 45% showed incorrect knowledge. In the bivariate analysis, a more favorable attitude was associated with: professional/clinical setting factors (medical profile/Zaragoza/Intensive Care/donor- generating and transplant-performing centers); information/education on organ donation and transplantation; social factors (conversations and support within the social environment); personal attitude (willingness to donate one's own organs and those of a relative); and knowledge/experience (AD, LLST, and cDCD) (p < 0.05). In the multivariable model, independent predictors of a favorable attitude were: working in Intensive Care (OR 1.98; IC95 % 1.17-3.36), professional activity linked to transplantation (OR 1.93; IC95 % 1.19-3.11), discussing organ donation and transplantation within the family/social environment (OR 1.80; IC95 % 1.10-2.95), favorable attitude toward donating one's own organs (OR 1.83; IC95 % 1.22-2.76), knowledge of LLST's legal regulation (OR 1.74; IC95 % 1.09-2.81), awareness that LLST is common practice in ICUs (OR 2.10; IC95 % 1.37-3.17), correct understanding of the cDCD concept (OR 2.82; IC95 % 1.59-4.99), and willingness to develop cDCD programs (OR 1.14; IC95 % 1.02-1.27).Conclusions: In a multicenter setting with clinical services heterogeneously exposed to cDCD, the proportion with a favorable attitude was low, with a high proportion of undecided respondents. Conceptual gaps were identified despite a high willingness to receive training. The favorable profile was associated with the professional environment (Intensive Care/transplantation), social support and interaction, and greater specific knowledge (cDCD/LLST). These findings support implementing targeted training strategies to reduce indecision and facilitate cDCD program development, which could, in turn, help increasedonation rates and alleviate transplant waiting lists.
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