Anticipated regret and organ donor registration: A randomized controlled trial

Health Psychol. 2016 Nov;35(11):1169-1177 doi: 10.1037/hea0000363.
Abstract
OBJECTIVE:

To test whether simply asking people to rate the extent to which they anticipate feeling regret for not registering as an organ donor after death increases subsequent verified organ donor registration.

METHOD:

There were 14,509 members of the general public (both registered and nonregistered donors) randomly allocated to 1 of 4 arms, each receiving different questionnaires. The no-questionnaire control (NQC) arm received a survey measuring demographics and whether or not they were registered organ donors. The questionnaire control (QC) arm completed the NQC questions plus questions regarding affective attitudes and intention to register as an organ donor. The theory of planned behavior (TPB) questionnaire arm received the QC questionnaire, plus additional items measuring TPB variables. The anticipated regret (AR) arm received the TPB questionnaire, plus 2 additional items measuring anticipated regret. The main outcome measures were number of nondonor participants who subsequently registered 6 months later, as verified by the United Kingdom national transplant register.

RESULTS:

Intention-to-treat (ITT) analysis in nonregistered donors (N = 9,139) revealed the NQC arm were more likely to register as an organ donor (6.39%) compared with the AR (4.51%) arm.

CONCLUSIONS:

A brief anticipated regret intervention led to a decrease in registration. A potential reason is discussed in terms of questionnaire item content "priming" negative perceptions of organ donation. This is a methodological concern that needs to be addressed in studies that use similar interventions. Current controlled trials: www.controlled-trials.com number: ISRCTN922048897. (PsycINFO Database Record

CET Conclusion
Reviewer: Centre for Evidence in Transplantation
Conclusion: This RCT tested whether the emotional factor anticipated regret can be used for interventions aimed at increasing organ donor registration. A randomly selected sample of 14,509 members of the general public were randomised to one of four intervention arms using simple randomisation. The four intervention arms each received a different questionnaire and participants were blind to the experimental arm. The sample size calculation showed that 3,630 participants were needed, which was based on the results of a pilot study, taking into account the proportion of the population already registered as an organ donor and an expected low response rate to questionnaires. The intention to treat analysis of 9,208 participants, showed that 5.4% of participants registered as an organ donor after receiving the questionnaire. However participants in the anticipated regret intervention arm were less likely to register compared with the no-questionnaire control arm. The authors suggest that future research should take into account the possible effect of items in a questionnaire on the effectiveness of a proposed intervention.
Expert Review
Reviewer: Dr Anna Forsberg, Transplant Nursing at Lund University, Sweden.
Conflicts of Interest: No
Clinical Impact Rating 3
Review: This article focus on the emotional factor: anticipated regret (AR) in relation to organ donation. One assumption was that AR should motivate people to undertake an action to avoid harmful future consequences. Thus, manipulating exposure to anticipated regret should result in increased levels of organ donation. The main hypothesis was that simply asking people to think about and rate their anticipated regret should result in greater rates of verified organ donor registration. Findings reveal that there was a significant association between gender and compliance with the protocol. Participants who complied with the intervention seemed to register for donation to a higher degree. Women were more likely to register than men. The most prominent finding was that people were less likely to register when being manipulated with items regarding anticipated regret. However, in the specific AR-group, the registration rates to donate were significantly greater among those with high anticipated regret. The generalizability of the study is good at least among European countries, or countries with similar socio-economic conditions. The authors seem surprised by their findings. However, it is reasonable that peoples' minds are not easy to manipulate with two negatively loaded items. To suggest that a person might anticipate regret is also to trigger feelings of possible guilt and shame. A well-established consequence from these emotions is denial, not wanting to deal with the question of concern. Thus, this large scale epidemiological study seemed to press the "denial-button" by their intervention and subsequently the participants in the intervention group did not increase their organ donation registration. When trying to increase donation registration it is probably more useful to use positive aspects of organ donation as a motivator rather than discussing the possibility of anticipated regret.
Methodological quality
Jadad score 4
Allocation concealment NO
Data analysis MODIFIED INTENTION TO TREAT
Study Details
Aims: To investigate whether simply asking people to rate the extent to which they anticipate feeling regret for not registering as an organ donor after death increases subsequent verified organ donor registration.
Interventions: The study involved 4 interventions with participants randomized to 1 of 4 arms, each receiving different questionnaires. The no-questionnaire control (NQC) arm received a survey measuring demographics and whether or not they were registered organ donors. The questionnaire control (QC) arm completed the NQC questions plus questions regarding affective attitudes and intention to register as an organ donor. The theory of planned behaviour (TPB) questionnaire arm received the QC questionnaire, plus additional items measuring TPB variables. The anticipated regret (AR) arm received the TPB questionn
Participants: Adult, Scottish, members of the general public, not registered on the NHSBT before the application pack was sent, were eligible for the study.
Outcomes: The primary outcome measures were number of nondonor participants who subsequently registered 6 months later, as verified by the United Kingdom national transplant register.
Follow Up: 6 months
Metadata
Publication type: Randomized Controlled Trial, Randomised Controlled Trial
Organ: Various
Language: English
MeSH terms: Adult; Attitude; Attitude to Death; Emotions; Female; Humans; Intention; Male; Middle Aged; Scotland; Surveys and Questionnaires; Tissue Donors; Tissue and Organ Procurement; United Kingdom