The clinical usefulness of autopsies : roles and attitudes of health care providers

Abstract

Background: The rate of autopsies has dropped to low levels in Western countries during the last four decades. In Sweden the rate of autopsy was 11% 2015.

Aim: The overall aim of the project was to study the background to the low levels of autopsies. One specific aim was to describe the attitudes of registered nurses (RN) and physicians (MD) toward clinical autopsy in neonatal and adult hospital care (I). Another was to investigate the clinical usefulness of autopsies for determining the cause of death and as a source of information for relatives (II).

Methods: A questionnaire was distributed to RNs and MDs in the following specialized clinics at Karolinska University Hospital: gastroenterology, hematology, geriatrics and neonatal care. A total of 336 surveys were distributed. The data were divided into two groups, neonatal care and adult care, and were analyzed with descriptive statistical methods. Three questions with free-text comments were analyzed with qualitative analysis (I). The process of post-mortem examination at the university hospital was investigated. A total of 53 autopsies were studied using data from medical records, including nurse´s records, autopsy request forms, autopsy reports and death certificates (II).

Results: The response rate was 35%, and the results were similar in the two groups. About 40% of the RNs had experience in participating in an autopsy. 14% of the MDs had only limited or no experience. Notably few RNs and approximately one-third of the MDs were familiar with the autopsy process and the treatment of the deceased person after an autopsy. More than one-third of the RNs had experience with talking to relatives regarding autopsy. Most responders agreed that an autopsy could be supportive for relatives during the grieving process and beneficial for the quality of health care. Most MDs thought that autopsies should be performed more frequently than they are today: however, 17% of the MDs did not agree that there should be a higher frequency of autopsies. The qualitative analysis provided a deeper understanding of the answers of the respondents (I). In two-thirds of the cases, the autopsy significantly altered or complemented the clinical picture in a way that was noted in the death certificate. In two-thirds of the cases, it was documented that the relatives was informed of the result of the autopsy. The frequency of autopsy request varied between 4% and 23% among the studied clinics. In six cases the relatives requested the examination (II).

Conclusion: The survey data confirmed the value of clinical autopsies in neonatal and adult hospital care. Clinical autopsy was a valuable source of information for the death certificates and for the relatives. The diagnostic value of autopsies in adult care was the same when autopsy frequencies was above 50%. RNs and MSs should receive training regarding the autopsy process and methods for obtaining consent for an autopsy. In addition, we believe that the RNs are in a good position to talk to the relatives of the possibilities of autopsy and offer a postmortem examination to get answers of questions raised by the relatives. RNs have an opportunity to take a more active role in the autopsy process as a member of a care team.