Horey Dell, Flenady Vicki, Conway Liz, McLeod Emma, Yee Khong Teck
Research Fellow, Research Education and Development Unit, La Trobe University, Melbourne, Vic.Associate Professor, Mater Medical Research Institute, University of Queensland, Brisbane, QldState Coordinator, SANDS Queensland, Brisbane, QldFounder and Director, Stillbirth Foundation Australia, Sydney, NSWConsultant, SA Pathology at Women's and Children's Hospital, University of Adelaide, Adelaide, SAMember, Australian and New Zealand Stillbirth Alliance (ANZSA), Woolloongabba, Qld, Australia.
Health Expect. 2014 Aug;17(4):534-44. doi: 10.1111/j.1369-7625.2012.00782.x. Epub 2012 Jun 19.
Stillbirth, among the most distressing experiences an adult may face, is also a time when parents must decide whether an autopsy or other post-mortem examinations will be performed on their infant. Autopsies can reveal information that might help explain stillbirth, yet little is known about how people make this difficult decision.
This study examines the influences on decisions about autopsy after stillbirth among Australian parents.
The study involved secondary analysis of transcripts of three focus groups using qualitative content analysis.
Seventeen parents of 14 stillborn babies participated in consultations around the revision of a perinatal mortality audit guideline.
Parents shared the decision making. Four decision drivers were identified: parents' preparedness or readiness to make decisions; parental responsibility; concern for possible consequences of an autopsy and the role of health professionals. Each decision driver involved reasons both for and against autopsy. Two decision aftermath were also present: some parents who agreed to an autopsy were dissatisfied with the way the autopsy results were given to them and some parents who did not have an autopsy for their infant expressed some form of regret or uncertainty about the choice they made.
To make decisions about autopsy after stillbirth, parents need factual information about autopsy procedures, recognition that there might be fear of blame, an environment of trust, and health services and professionals prepared and skilled for difficult conversations.
死产是成年人可能面临的最痛苦经历之一，也是父母必须决定是否对其婴儿进行尸检或其他死后检查的时候。尸检可以揭示有助于解释死产原因的信息，但人们如何做出这一艰难决定却鲜为人知。
本研究探讨澳大利亚父母在死产后对尸检决定的影响因素。
本研究采用定性内容分析法对三个焦点小组的记录进行二次分析。
14名死产婴儿的17位父母参与了围产期死亡审核指南修订的咨询。
父母共同参与决策。确定了四个决策驱动因素：父母做出决定的准备程度；父母的责任；对尸检可能后果的担忧以及医护人员的作用。每个决策驱动因素都包含支持和反对尸检的理由。还出现了两种决策后果：一些同意尸检的父母对尸检结果的告知方式不满意，一些未对其婴儿进行尸检的父母对自己的选择表达了某种形式的遗憾或不确定。
为了在死产后做出关于尸检的决定，父母需要有关尸检程序的事实信息，认识到可能存在的罪责恐惧，一个信任的环境，以及准备好且有能力进行艰难对话 的医疗服务机构和专业人员。
