Provider attitudes about gaining consent for perinatal autopsy.
ABSTRACT 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.
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, chi(2), and generalized estimating equation tests.
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.
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.
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ABSTRACT: To describe the experiences, knowledge and views of both parents and professionals regarding the consent process for perinatal postmortem. Internet-based survey. Obstetricians, midwives and perinatal pathologists currently working in the UK. Parents who have experienced a stillbirth in the UK in the previous 10 years. Obstetricians, midwives and perinatal pathologists registered with their professional bodies. Parents who accessed the Sands website or online forum. Online self-completion questionnaire with both fixed-choice and open-ended questions. Responses were analysed from 2256 midwives, 354 obstetricians, 21 perinatal pathologists and 460 parents. The most common reason for parents to request postmortem examination was to find a cause for their baby's death; the prevention of stillbirths in others also ranked highly. Perinatal pathologists possessed greatest knowledge of the procedure and efficacy of postmortem, but were unlikely to meet bereaved parents. The majority of professionals and parents ranked emotional distress and a lengthy wait for results as barriers to consent. The majority of staff ranked workload, negative publicity, religion and cultural issues as important barriers, whereas most parents did not. Almost twice as many parents who declined postmortem examination later regretted their decision compared with those who accepted the offer (34.4 versus 17.4%). Emotional, practical and psychosocial issues can act as real or perceived barriers for staff and bereaved parents. Education is required for midwives and obstetricians, to increase their knowledge to ensure accurate counselling, with due regard for the highly individual responses of bereaved parents. The contribution of perinatal pathologists to staff education and parental decision-making would be invaluable.BJOG An International Journal of Obstetrics & Gynaecology 05/2012; 119(8):987-97. · 3.76 Impact Factor
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ABSTRACT: A complete fetal/perinatal autopsy includes external examination, dissection and examination of internal organs with consecutive histological sampling, microbiological and virological studies as well as the use of sophisticated techniques for cytogenetic and metabolic laboratory investigation. Additional post-mortem X-ray is essential in cases of skeletal abnormalities. Sufficient clinical information and specification of clinical questions is especially important in cases where macroscopic performance may be limited due to small size and/or autolysis. Apart from the most obvious, namely to explain causes and mechanisms of death and disease, the still undisputed manifold benefits obtained from an autopsy in case of fetal perinatal and neonatal death include assurance and improvement of medical quality as well as teaching and research. However, a worldwide decline in autopsy rates over the past decades resulted in a drop of fetal/perinatal autopsies below the level of 75%, which is considered the minimal requirement for quality assurance. Since difficulties in obtaining parenteral consent for a complete autopsy was felt to represent a major reason for this decline, post-mortem MRI was brought up as a possible alternative method, as part of the concept of so called less/minimally invasive autopsies. Systematic and evidence based reviews of studies comparing post-mortem MRI with conventional autopsies however showed that diagnostic accuracy of this method is still insufficient to replace autopsies. Among the reasons for the decline in autopsy rates, misconceptions about autopsies by parents and clinicians are mentioned in the literature. Rehabilitation of the autopsy as a tool of surveillance, teaching and research therefore also seems to require reeducation of the professionals, which should be based on better interdisciplinary communication. On the other hand, places with still adequate autopsy rates, like we have in Vienna, should establish large scale studies, to clearly demonstrate the position pm MRI examination has in the performance of a fetal/perinatal autopsy.
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ABSTRACT: Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby.Birth 03/2012; 39(1):57-64. · 2.93 Impact Factor