Khong T Y, Turnbull D, Staples A
Department of Histopathology, and Division of Paediatric Medicine, Women's and Children's Hospital, Adelaide, Australia.
Obstet Gynecol. 2001 Jun;97(6):994-8. doi: 10.1016/s0029-7844(01)01123-1.
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.
调查新生儿科医生、产科医生、助产士和新生儿护士对围产期尸检的态度，并就他们认为会影响女性尸检同意决定的医生进行调查。
通过邮寄方式进行一项调查，其中包含一份由八个虚构病例场景组成的问卷，并将三个因素（生前诊断的信心、未来怀孕的意愿以及父母对尸检的态度）进行各种排列组合，发送给澳大利亚的各类医生和护士（所有在新生儿重症监护病房工作的顾问新生儿科医生以及三级妇产医院的顾问产科医生、助产士和新生儿护士样本）。要求受访者在七点李克特量表（1 = 肯定不会，7 = 肯定会）上对他们寻求尸检同意或建议进行尸检的可能性进行评分。通过方差分析测量因素与受访者之间的相互作用，并使用曼-惠特尼U检验、卡方检验和广义估计方程检验比较差异。
总体回复率为70%（新生儿科医生为57%，产科医生为62%，助产士为77%，新生儿护士为75%）。与新生儿护士（中位数得分5；四分位间距为2, 6）相比，新生儿科医生（中位数得分7，四分位间距为7, 7）更有可能要求进行尸检（P <.001），产科医生（中位数得分7；四分位间距为7, 7）与助产士（中位数得分6；四分位间距为3, 7）相比也是如此（P <.001）。医生认为助产士和新生儿护士对母亲关于尸检同意的决定有一定到很大的影响。
医生并不反对寻求围产期尸检的同意。助产士和护士会受到所研究的三个因素的影响，这可能会对围产期尸检的同意率产生负面影响。应考虑旨在改变护士态度的干预策略。
