Stolman C J, Castello F, Yorio M, Mautone S
Department of Pediatrics, University of Medicine and Dentistry of New Jersey.
Arch Pediatr Adolesc Med. 1994 Aug;148(8):843-7. doi: 10.1001/archpedi.1994.02170080073014.
To investigate attending physician and resident attitudes and factors affecting autopsy consent.
A validated, self-report, multiple-choice questionnaire was administered to 158 physicians.
The overall response rate was 113 (72%), with 57 (85%) of 67 pediatric residents and 51 (56%) of 91 attending physicians responding. The status of five respondents was unknown. Most respondents (98%) believed autopsies provide valuable information; physicians who had graduated before 1980 were more likely to believe that the benefits of autopsy should be taught (P < or = .002). Autopsy was considered unnecessary by 20% (22/112) when the disease was known before death and by 11% (12/112) when the patient was designated "do not resuscitate." Physicians who did not attend an autopsy while in training were less likely to believe in the benefits of autopsy (P < or = .02). Factors that influenced the failure to obtain consent for an autopsy were physician belief that the family felt the body would be desecrated (30/81 [37%]); physician belief that the family would be upset (36/104 [35%]); and physician belief that little information would be obtained (19/104 [18%]). Fourteen (17%) of 81 physicians indicated that they do not ask permission for autopsy if the family is upset.
Most physicians believe autopsies have benefit. If the autopsy rate is to improve, physicians in training will require increased exposure to autopsies, education regarding the potential benefits, and enhancement of interpersonal skills for successful communication with families in crisis.
调查主治医师和住院医师对于尸检同意书的态度及影响因素。
向158名医师发放一份经过验证的、自我报告式的多项选择题问卷。
总回复率为113（72%），其中67名儿科住院医师中有57名（85%）回复，91名主治医师中有51名（56%）回复。5名受访者的身份不明。大多数受访者（98%）认为尸检能提供有价值的信息；1980年以前毕业的医师更有可能认为应该传授尸检的益处（P≤0.002）。当死亡前已知疾病时，20%（22/112）的人认为尸检不必要；当患者被指定为“不要复苏”时，11%（12/112）的人认为不必要。在培训期间未参加过尸检的医师不太相信尸检的益处（P≤0.02）。影响未获得尸检同意的因素包括：医师认为家属会觉得尸体被亵渎（30/81[37%]）；医师认为家属会难过（36/104[35%]）；医师认为得不到什么信息（19/104[18%]）。81名医师中有14名（17%）表示，如果家属难过，他们不会询问尸检许可。
大多数医师认为尸检有益。如果要提高尸检率，接受培训的医师需要增加尸检经历、接受关于潜在益处的教育，并提高与处于危机中的家属成功沟通的人际沟通技巧。
