Provider attitudes about gaining consent for perinatal autopsy☆
Section snippets
Materials and methods
From the Australian and New Zealand Neonatal Network, a registry of all accredited neonatologists, we identified consultant neonatologists from Australia’s 23 NICUs. We used a cluster sample method to identify obstetricians, neonatal nurses, and midwives. To gather respondents from other health professional categories, we selected one hospital with a NICU from each state or territory. There was only one such hospital in two states or one territory (Tasmania, Western Australia, and Australian
Results
The overall response rate to the questionnaire was 70% (neonatologists 65 of 114, 57%; obstetricians 56 of 90, 62%; midwives 133 of 172, 77%; and neonatal nurses 194 of 258, 75%). Table 1 gives the median and mean scores for all scenarios. The response scores were different between obstetricians and midwives (P < .001) and between neonatologists and neonatal nurses (P < .001), even after adjusting for cluster effects using the generalized estimating equation model.
For one scenario that had a
Discussion
Seeking permission for a perinatal postmortem examination is difficult, and many factors influence the attendant’s decision to ask.13 We did not examine some factors, such as parental ethnicity, parity, gestational age at delivery, length of stay in NICU, possible litigation, availability of perinatal pathologist expertise, and reimbursement costs of autopsy because they have been the subject of previous research.15, 16, 17, 18 Perinatal autopsies also are free to parents, and perinatal
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Cited by (25)
Consent for paediatric and perinatal postmortem investigations: Implications of less invasive autopsy
2016, Journal of Forensic Radiology and ImagingCitation Excerpt :Some healthcare professionals may suggest that a post-mortem examination is not necessary, as the cause of death is adequate [10,11]. In such circumstances, the quality of the information given to parents by healthcare professionals, as well as the personal beliefs of the consent taker, have been identified as potential barriers to some parents consenting to a post-mortem [3,12,13]. Professional staff training may help to remove these barriers.
Interventions to improve rates of post-mortem examination after stillbirth
2010, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :We found that when authorization for a post-mortem was granted, a senior member of staff was more likely to have carried out counselling than junior doctors or midwives. Senior staff are more likely to believe in the value of autopsy than junior staff [14] and in many cases a consultant involved in the care of the woman, or a specialist bereavement midwife will be the most appropriate person to request consent. Changing our unit guidelines to stipulate that only senior staff should offer post-mortem has been associated with improvement in post-mortem rates.
A multilayered approach for the analysis of perinatal mortality using different classification systems
2009, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Systems that classify the underlying cause of death require an extensive analysis of cases for optimal use, especially the autopsy and histopathologic placental examinations, as mentioned earlier in this manuscript. Perinatal autopsy rates in many developed countries however have shown a diminishing trend mainly because lack of consent, although placental examination is usually allowed [22]. In developing countries the perinatal autopsy rates are also low because the facilities for the autopsy are only available in larger hospitals and in general the autopsy does not have medical priority.
The perinatal autopsy: Pertinent issues in multicultural Western Europe
2007, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :This process can be further enhanced by understanding possible religious or cultural sensitivities to the autopsy as clinicians and paramedical staff have a role to play in requesting an autopsy or to persuade parents to allow use of tissue for research and educational purposes [2].
Postmortem MR imaging of the fetus: An adjunct or a replacement for conventional autopsy?
2005, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Accurate explanations of the procedure and findings are important in helping parents reach a decision. It has been suggested, and is practised in some hospitals,8 that the pathologist obtains consent for the autopsy, as pathologists are the people best placed to explain the process to the parents8–10; however, the optimal combination may be the clinical consultant responsible for the patient's care together with the pathologist. The increasing length and complexity of the consent forms with which doctors have to be familiar and parents have to read also add to the difficulties in obtaining permission for autopsy.
Restoring high neonatal autopsy rates [5]
2004, Lancet
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Supported by the Adelaide Women’s and Children’s Hospital Perinatal Pathology Trust Fund. The authors thank Nicole Pratt for additional statistical assistance. Copies of the questionnaires and the analysis of variance tables are available from the corresponding author on request.