Provider attitudes about gaining consent for perinatal autopsy

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Abstract

Objective: To examine the attitudes of neonatologists, obstetricians, midwives, and neonatal nurses toward perinatal autopsy and survey physicians about whom they perceive influence women’s decisions on autopsy consent.

Methods: A postal survey that incorporated a questionnaire of eight fictitious case scenarios and combined three factors (confidence of antemortem diagnosis, intention to have future pregnancy, and parental attitude toward autopsy) in various permutations was sent to various Australian physicians and nurses (all consultant neonatologists working in neonatal intensive care units and a sample of consultant obstetricians, midwives, and neonatal nurses in level III maternity hospitals). Respondents were asked to rate how likely they were to seek consent for or suggest autopsies on a seven-point Likert scale (1 = certainly will not, 7 = certainly will). Interactions between factors and respondents were measured by analysis of variance, and differences were compared using Mann-Whitney U, χ2, and generalized estimating equation tests.

Results: The overall response rate was 70% (neonatologists 57%, obstetricians 62%, midwives 77%, and neonatal nurses 75%). Neonatologists (median score 7, interquartile range 7, 7) were more likely to ask for autopsies than neonatal nurses (5; 2, 6) (P < .001), as were obstetricians (7; 7, 7) compared with midwives (6; 3, 7) (P < .001). Physicians rated midwives and neonatal nurses as having some to substantial influence on mothers’ decisions about consent for autopsy.

Conclusion: Physicians are not averse to seeking consent for perinatal autopsies. Midwives and nurses are influenced by the three factors studied, which might negatively influence the consent rate for perinatal autopsies. Intervention strategies aimed at changing nurses’ attitudes should be considered.

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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    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.

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