Do cognitive-affective and family communication variables impact individual decisions to discuss organ donation wishes?
Family discussion of donation wishes is a critical driver of family authorisation of organ donation. However, few people discuss their wishes or feel certain of family member’s donation preferences. Empirically, individual determinants of discussing donation wishes with family have been examined using the theory of planned behaviour (TPB). The impact of cognitive-affective (e.g., disgust) and family (e.g., family communication) variables are less well studied, and not integrated together in decision-making frameworks. To address this gap, the role of family communication and ‘cognitive-affective’ variables, integrated within the TPB, were examined as predictors of intended and actual discussion of donation wishes with family. Participants (N=201) completed baseline measures of family communication, cognitive-affective (disgust, bodily integrity, medical mistrust, fear of not being dead, anxiety about discussing), and TPB (attitude, subjective norm, self-efficacy, intention) variables. Two-weeks later, participants (N=111) self-reported their discussion behaviour (n=42, 38% discussed). A revised structural equation model provided a good fit to these data. In this model, less anxiety about discussion and positive attitudes toward discussion predicted self-efficacy (R2=0.67). Positive attitudes, greater self-efficacy and perceived approval/support from important others (subjective norm) predicted discussion intentions (R2=0.70). Intention predicted discussion behaviour (R2=0.22). Cognitive-affective variables (except discussion anxiety) and family communication did not have a prominent role. Interventions which emphasise that family expect and approve of donation discussions, portray donation discussions as positively valued, and bolster self-efficacy are needed to increase discussion of organ donation wishes. Bolstering self-efficacy could be achieved by providing tangible strategies to assist individuals to reduce their anxiety about discussing their wishes, and encouraging positive attitudes towards discussion and its importance in family authorisation for donation.