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Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study

Lewis, C; Hill, M; Arthurs, OJ; Hutchinson, JC; Chitty, LS; Sebire, N; (2018) Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study. Archives of Disease in Childhood , 103 (6) pp. 572-578. 10.1136/archdischild-2017-314424. Green open access

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Abstract

OBJECTIVE: To assess health professionals’ and coroners’ attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting. METHODS: A qualitative study using semistructured interviews. Data were analysed thematically. RESULTS: Twenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers. CONCLUSION: Health professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.

Type: Article
Title: Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/archdischild-2017-314424
Publisher version: http://doi.org/10.1136/archdischild-2017-314424
Language: English
Additional information: © Article author(s) (or their employer[s] unless otherwise stated in the text of the article) 2018. All rights reserved. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/).
Keywords: autopsy, less invasive, paediatric, perinatal, post mortem
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Genetics and Genomic Medicine Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10045927
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