Audit study of next of kin's satisfaction with clinical necropsy service

Abstract

The public may have considerable appreciation of the nature and purposes of necropsy,' but these attitudes could change when people are faced with requests for necropsies on members of their own family. We investigated the level of satisfaction of bereaved relatives with a clinical necropsy service. Subjects, methods, and resultsWe selected 206 consecutive requests for clinical necropsies for inclusion in our study. At least six months (range 6-14 months) after the requests had been made, a specially trained academic psychologist tried to contact the relatives whose consent had been requested. Sixty seven of the relatives were excluded because they could not be contacted, they gave incomplete information, or there were issues of confidentiality or litigation. Of the remaining 139 relatives, 75 participated in the study-31 by the preferred method of personal interview, 31 by postal questionnaire, and 13 by telephone interview. Consent for necropsy had been given by 44 (59%) of the participants and 36 (56%) of the non-responders. Our open ended survey focused on how necropsy requests were made, relatives' reasons for their response, interference with funeral arrangements, and communication of results.The doctors who made the requests were 39 house officers, 13 senior house officers, 13 consultants, six senior registrars, and four registrars. Thirteen relatives were distressed by requests, primarily because of a lack of warning, poor timing, and failure to explain the reasons for the request. Distress did not affect relatives' response to the request, nor did the requesting doctor's clinical grade. Table 1 summarises the other main findings related to request procedures.The commonest reasons for refusing necropsy consent were failure to see any purpose for an necropsy, belief that the deceased had suffered enough, and dislike of the idea of a necropsy. Religious objections were rare. The commonest reasons for giving consent were to help others, desire for more information about deaths, and to assist medical science or research. Four necropsies interfered with funeral arrangements, always because ofpoor communication between mortuary staff and funeral directors. Only 17 relatives obtained necropsy results, and in three cases these were delayed for over a month. Delay in the issue of necropsy reports was the commonest reason for relatives not receiving results. The main benefits reported by the relatives who received results were reassurance and peace of mind. Four relatives reported no benefit. CommentAlthough this is essentially a local study, many of its findings may be relevant nationally. The high number of relatives distressed by requests for necropsies is unacceptable. No guidelines currently exist about this procedure despite the fact that the best clinical care can be undermined by failure to respond sensitively to bereaved relatives.2 Any loss of public support for necropsies will compromise efforts to increase necropsy rates for research, education, and audit. Our study of relatives' satisfaction with a cl...

Referral for autopsies: analysis of 651 consecutive deaths in one general practice

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“…However, an increase in rate is unlikely unless the public and primary and secondary care clinicians are made aware of the value of autopsies. Some have suggested that training should be provided for all grades of doctors in communication skills for dealing with death and dying 1. Better communication between GPs, hospital clinicians, pathologists, and coroners may also increase the rate of autopsies.…”

Perinatal pathology in the context of a clinical trial: attitudes of bereaved parents

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Broken doctor–patient relationships: why won't they listen?

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