Birdi K S, Bunce D J, Start R D, Cotton D W
Department of Psychology, University of Sheffield, UK.
Postgrad Med J. 1996 Apr;72(846):224-8. doi: 10.1136/pgmj.72.846.224.
The aim of the study was to use psychological theory to identify and evaluate factors influencing clinical autopsy requests. A series of pilot interviews were conducted with 20 clinicians to identify beliefs about the benefits and drawbacks, social groups and circumstances influential in the decision to make an autopsy request. The most common beliefs, together with measures of intention to request autopsies, were incorporated into a questionnaire which was distributed among all appropriate clinicians in four hospitals. Statistical analyses identified which beliefs had the most influence on clinicians' intentions to request autopsies. A total of 145 clinicians returned the questionnaire, a response rate of 42%. Clinicians were significantly more likely to request autopsy the more they thought that the outcome of requesting would be of educational value, would confirm clinical diagnoses, would not distress relatives, would not be time-consuming and that the request itself would receive support from their consultant. An autopsy request was unlikely in circumstances where clinicians felt uncomfortable when requesting relatives' permission and when the patients were elderly. The fear of causing distress to relatives and the degree of support from the clinician's consultant were found to be the strongest predictors of intention to request autopsies. These are two areas in which intervention could help to increase autopsy request rates.
本研究的目的是运用心理学理论来识别和评估影响临床尸检申请的因素。对20名临床医生进行了一系列试点访谈，以确定他们对于尸检的益处和弊端、在决定提出尸检申请时具有影响力的社会群体及情况的看法。最常见的看法以及尸检申请意向的衡量指标被纳入一份问卷，该问卷分发给了四家医院所有合适的临床医生。统计分析确定了哪些看法对临床医生提出尸检申请的意向影响最大。共有145名临床医生返还了问卷，回复率为42%。临床医生越认为提出尸检申请的结果具有教育价值、能证实临床诊断、不会使亲属痛苦、不会耗时且申请本身会得到其顾问的支持，就越有可能提出尸检申请。当临床医生在请求亲属许可时感到不自在以及患者为老年人的情况下，不太可能提出尸检申请。研究发现，担心给亲属造成痛苦以及临床医生顾问的支持程度是提出尸检申请意向的最强预测因素。这是两个通过干预有助于提高尸检申请率的领域。
