ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
PLoS One. 2018 Jul 6;13(7):e0200058. doi: 10.1371/journal.pone.0200058. eCollection 2018.
The minimally invasive autopsy (MIA) is being investigated as an alternative to the complete diagnostic autopsy (CDA), gold standard for CoD determination, in settings where CDA is unfeasible and/or unacceptable. We aimed to explore healthcare providers' views and perceptions on theoretical and factual acceptability of the CDA and the MIA.
A qualitative study, combining ethnographic and grounded-theory approaches, was conducted within a project aiming to validate the MIA tool against the CDA for CoD investigation. We present data on in-depth and semi-structured interviews of 33 healthcare providers operating within the formal and informal health services in Southern Mozambique. MIA perception was analysed through the theory of diffusion of innovations.
All participants considered CDA useful for CoD determination. CDA was perceived reliable, but the unpleasant nature of the procedure and its associated infection risk were the main perceived disadvantages. Participants considered the MIA simple, easy and quick to perform; likely to meet families' expectations to know the CoD, and able to provide evidence-based knowledge for disease management. Concerns were raised on its reliability compared to the CDA. Family's emotional status and accessibility to decision-makers were mentioned as principal barriers for MIA performance. The main jeopardizing factors for MIA implementation were the shortage of required resources and the significant proportion of people dying at home. Key facilitators for MIA acceptance included the need for the support from community and religious leaders, provision of clear information to the community, and accompaniment to bereaved families.
Healthcare providers consider the MIAs potentially more acceptable and feasible than CDAs in places where the latter have shown significant implementation challenges. A clear understanding of healthcare provider's perceived barriers and facilitators for conducting post-mortem procedures in general, and MIAs in particular, will shed light on their future field implementation for more robust mortality surveillance.
微创尸检 (MIA) 作为死因确定的金标准——全面诊断尸检 (CDA) 的替代方法，正在进行研究，适用于 CDA 不可行和/或不可接受的情况。我们旨在探讨医疗保健提供者对 CDA 和 MIA 的理论和实际可接受性的看法和看法。
一项定性研究结合了民族志和扎根理论方法，在一个旨在验证 MIA 工具与 CDA 用于死因调查的项目中进行。我们介绍了对在莫桑比克南部正规和非正规卫生服务中工作的 33 名医疗保健提供者进行深入和半结构化访谈的数据分析。通过创新扩散理论分析 MIA 认知。
所有参与者都认为 CDA 有助于确定死因。CDA 被认为是可靠的，但程序的不愉快性质及其相关的感染风险是主要的认知障碍。参与者认为 MIA 简单、易于操作且快速进行；很可能满足家属了解死因的期望，并能够提供基于证据的疾病管理知识。与 CDA 相比，人们对其可靠性提出了担忧。家属的情绪状态和决策者的可及性被认为是进行 MIA 的主要障碍。MIA 实施的主要威胁因素是所需资源短缺和大量人在家中死亡。MIA 接受的主要促进因素包括社区和宗教领袖的支持、向社区提供清晰的信息以及对丧亲家庭的陪伴。
医疗保健提供者认为，在 CDA 实施面临重大挑战的地方，MIA 比 CDA 更具可接受性和可行性。清楚地了解医疗保健提供者对进行尸检程序的认知障碍和促进因素，特别是 MIA，将为它们在未来更有力的死亡率监测中的现场实施提供依据。
