TY - JOUR
T1 - Resurrecting the hospital autopsy
T2 - Impact of an office of decedent affairs on consent rates, providers, and next-of-kin
AU - Juskewitch, Justin E.
AU - Griffin, Joan M.
AU - Maleszewski, Joseph J.
AU - Asiedu, Gladys B.
AU - Paolini, Michael A.
AU - Regnier, Angela K.
AU - Yrjo, Melanie L.
AU - Kendall, Monica L.
AU - Comfere, Nneka I.
AU - Cheville, Andrea L.
AU - Carey, Elise C.
AU - Amirahmadi, Fazlollaah
AU - Rabatin, Jeffrey T.
AU - Moynihan, Timothy J.
AU - Ross Reichard, R.
AU - Aubry, Marie Christine
N1 - Publisher Copyright:
© 2021 College of American Pathologists. All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Context.-Autopsy rates have decreased dramatically despite providing important clinical information to medical practices and social benefits to decedents' families. Objective.-To assess the impact of an institutional Office of Decedent Affairs (ODA), a direct communication link between pathology and decedents' families, on hospital autopsy consent rates, autopsy-related communication, practitioner views, and next-of-kin experiences. Design.-A before and after study involving all hospital decedents whose deaths did not fall within the jurisdiction of the medical examiner's office from 2013 to 2018. A pathology-run ODA launched in May 2016 to guide nextof- kin through the hospital death process (including autopsy-related decisions) and serve as the next-of-kin's contact for any subsequent autopsy-related communication. Critical care and hematology/oncology practitioners were assessed for their autopsy-related views and decedents' next-of-kin were assessed for their autopsy-related experiences. Autopsy consent rates for non-medical examiner hospital deaths, autopsy-related communication rates, practitioner views on the role and value of autopsy, and next-of-kin autopsy experiences and decisions factors were compared prior to and after ODA launch. Results.-Autopsy consent rates significantly increased from 13.2% to 17.3% (480 of 3647 deaths versus 544 of 3148 deaths; P , .001). There were significant increases in the rate of autopsy-related discussions and bereavement counseling provided to decedents' families. Practitioner views on the positive role of autopsy for any hospital death and those with advanced stage cancer also significantly increased. Next-of-kin indicated more consistent autopsyrelated discussions with the potential benefits of autopsy discussed becoming key decision factors. Conclusions.-An ODA improves hospital autopsy consent rates, autopsy-related communication, providers' autopsy-related views, and next-of-kins autopsy experiences.
AB - Context.-Autopsy rates have decreased dramatically despite providing important clinical information to medical practices and social benefits to decedents' families. Objective.-To assess the impact of an institutional Office of Decedent Affairs (ODA), a direct communication link between pathology and decedents' families, on hospital autopsy consent rates, autopsy-related communication, practitioner views, and next-of-kin experiences. Design.-A before and after study involving all hospital decedents whose deaths did not fall within the jurisdiction of the medical examiner's office from 2013 to 2018. A pathology-run ODA launched in May 2016 to guide nextof- kin through the hospital death process (including autopsy-related decisions) and serve as the next-of-kin's contact for any subsequent autopsy-related communication. Critical care and hematology/oncology practitioners were assessed for their autopsy-related views and decedents' next-of-kin were assessed for their autopsy-related experiences. Autopsy consent rates for non-medical examiner hospital deaths, autopsy-related communication rates, practitioner views on the role and value of autopsy, and next-of-kin autopsy experiences and decisions factors were compared prior to and after ODA launch. Results.-Autopsy consent rates significantly increased from 13.2% to 17.3% (480 of 3647 deaths versus 544 of 3148 deaths; P , .001). There were significant increases in the rate of autopsy-related discussions and bereavement counseling provided to decedents' families. Practitioner views on the positive role of autopsy for any hospital death and those with advanced stage cancer also significantly increased. Next-of-kin indicated more consistent autopsyrelated discussions with the potential benefits of autopsy discussed becoming key decision factors. Conclusions.-An ODA improves hospital autopsy consent rates, autopsy-related communication, providers' autopsy-related views, and next-of-kins autopsy experiences.
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U2 - 10.5858/arpa.2019-0571-OA
DO - 10.5858/arpa.2019-0571-OA
M3 - Article
C2 - 33367663
AN - SCOPUS:85086663609
SN - 0003-9985
VL - 145
SP - 55
EP - 65
JO - Archives of Pathology and Laboratory Medicine
JF - Archives of Pathology and Laboratory Medicine
IS - 1
ER -