Design, implementation, and evaluation of a knowledge translation intervention to increase organ donation after cardiocirculatory death in Canada: a study protocol

Abstract

BackgroundA shortage of transplantable organs is a global problem. There are two types of organ donation: living and deceased. Deceased organ donation can occur following neurological determination of death (NDD) or cardiocirculatory death. Donation after cardiocirculatory death (DCD) accounts for the largest increments in deceased organ donation worldwide. Variations in the use of DCD exist, however, within Canada and worldwide. Reasons for these discrepancies are largely unknown. The purpose of this study is to develop, implement, and evaluate a theory-based knowledge translation intervention to provide practical guidance about how to increase the numbers of DCD organ donors without reducing the numbers of standard NDD donors.MethodsWe will use a mixed method three-step approach. In step one, we will conduct semi-structured interviews, informed by the Theoretical Domains Framework, to identify and describe stakeholders’ beliefs and attitudes about DCD and their perceptions of the multi-level factors that influence DCD. We will identify: determinants of the evidence-practice gap; specific behavioural changes and/or process changes needed to increase DCD; specific group(s) of clinicians or organizations (e.g., provincial donor organizations) in need of behaviour change; and specific targets for interventions. In step two, using the principles of intervention mapping, we will develop a theory-based knowledge translation intervention that encompasses behavior change techniques to overcome the identified barriers and enhance the enablers to DCD. In step three, we will roll out the intervention in hospitals across the 10 Canadian provinces and evaluate its effectiveness using a multiple interrupted time series design.DiscussionWe will adopt a behavioural approach to define and test novel, theory-based, and ethically-acceptable knowledge translation strategies to increase the numbers of available DCD organ donors in Canada. If successful, this study will ultimately lead to more transplantations, reducing patient morbidity and mortality at a population-level.

Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six”

“…Both the TDF and BCT Taxonomy (v1), however, are becoming increasingly popular for understanding clinical behaviour and guiding implementation intervention design “from scratch”. Examples of published work using the TDF and BCT Taxonomy to guide quality improvement are seen in antibiotic prescribing [ 30 ] and organ donation [ 31 ], but to the authors’ knowledge, they have not yet been used in the design of interventions to improve implementation sepsis guidelines. In addition, as far as we are aware, this is the first example of a study that has used these tools to “enhance” an existing pragmatically developed intervention.…”

“…The BCT Taxonomy (v1) has also been used to identify active ingredients in other existing implementation interventions. Both tools have been used to inform the design of various implementation interventions in healthcare settings [ 30 , 31 ]. In the current study, an existing pragmatically designed quality improvement programme, which had achieved some level of success, was already ongoing.…”

Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle

“…One systematic review by Laba and colleagues [ 32 ] used both the Behaviour Change Wheel and an earlier version of the BCT Taxonomy to classify strategies used to improve adherence to cardiovascular medications across 14 studies [ 33 ]. Examples of using the BCT Taxonomy to guide intervention development on the basis of TDF analyses are seen in antibiotic prescribing [ 34 ] and organ donation [ 35 ]. A common scenario in clinical practice is that of having interventions in place which have achieved some level of success, but are not fully reported or understood and may require improvement.…”

Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings

“…This study further demonstrated the usefulness of using a behavioural analysis approach to identify the behavioural content of interventions and assess how well these address the barriers to desired behaviour change. A number of studies showed the strengths of such approaches in other contexts [ 48 , 49 , 50 ]. We built on this theoretical approach by focusing on interventions which had shown to be effective research at changing the target behaviours and consulting expert stakeholders to develop new intervention components.…”

“…We used the Behaviour Change Wheel (BCW), Theoretical Domains Framework (TDF) and the 93-item taxonomy of Behaviour Change Techniques (BCTTv1) to describe the behavioural content of interventions. The BCW enables characterisation of interventions using nine intervention functions, i.e., purposes that an intervention may serve; and seven policy categories, i.e., channels through which interventions are implemented [ 4 , 48 ] The TDF is an integrative framework of 14 theoretical domains of influences on behavior [ 49 ]. Behaviour change techniques (BCTs) are defined as active ingredients of interventions designed to bring about change [ 50 ].…”