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Tutty E, Horsley P, Forbes Shepherd R, Forrest LE. The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences. Palliat Med 2021; 35:437-446. [PMID: 33126839 DOI: 10.1177/0269216320967595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND CASCADE is a successful, Australia-first cancer rapid autopsy programme. Patients are recruited to the programme by their clinician once they understand that further treatment has only palliative intent. Despite its value, rapid autopsy is a rare research method owing partly to recruitment challenges. AIM This research aimed to explore (1) how, in practice, clinicians select and recruit patients to the programme and (2) patient experiences of this process. DESIGN This was a qualitative study grounded in phenomenology. CASCADE team members (clinicians and researchers) and patients participated in semi-structured interviews. Data were analysed using an inductive, team-based approach to thematic analysis. PARTICIPANTS Interviews were conducted with 31 participants (11 patients and 20 CASCADE team members). RESULTS Patient selection and recruitment to a rapid autopsy programme is both an art and science. In practice, patient selection is a subjective process that involves assessing a patient's psychosocial suitability for the programme. Trust and rapport are necessary for informing this assessment and to create an environment conducive to discussing rapid autopsy. Clinicians have also crafted their own ways of delivering information about CASCADE, with both clinicians and patients acknowledging that, if not handled sensitively, recruitment could cause distress. Overall, patients were satisfied with the way in which they were recruited. CONCLUSION Findings provide insight into how clinicians successfully select and recruit patients to a rapid autopsy programme and suggests that discussing such topics are acceptable to end-of-life patients. This research also raises thought-provoking questions about the 'gatekeeping' role of clinicians in recruitment.
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Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Philomena Horsley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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Mentink MG, Bakers FCH, Mihl C, Lahaye MJ, Rennenberg RJMW, Latten BGH, Kubat B, Hofman PAM. Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study. J Clin Pathol 2020; 74:177-181. [PMID: 32675309 DOI: 10.1136/jclinpath-2020-206734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/03/2022]
Abstract
AIM The aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed. METHODS For a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility. RESULTS The postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient. CONCLUSIONS Our study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.
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Affiliation(s)
- Max G Mentink
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Frans C H Bakers
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Radiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Bart G H Latten
- Department of Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Pathology, Netherlands Forensic Institute, Den Haag, The Netherlands
| | - Bela Kubat
- Department of Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.,Department of Pathology, Netherlands Forensic Institute, Den Haag, The Netherlands
| | - Paul A M Hofman
- Department of Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
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Ducatman BS, Ducatman AM, Crawford JM, Laposata M, Sanfilippo F. The Value Proposition for Pathologists: A Population Health Approach. Acad Pathol 2020; 7:2374289519898857. [PMID: 31984223 PMCID: PMC6961144 DOI: 10.1177/2374289519898857] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023] Open
Abstract
The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of populations and improve health-care outcomes for both individual patients and populations. For the profession to thrive, pathologists will need to focus on extending their roles outside the laboratory beyond the traditional role in the analytic phase of testing. This should include leadership in ensuring correct ordering and interpretation of laboratory testing and leadership in population health programs. Pathologists in training will need to learn key concepts in informatics and data analytics, health-care economics, public health, implementation science, and health systems science. While these changes may reduce reimbursement for the traditional activities of pathologists, new opportunities arise for value creation and new compensation models. This report reviews these opportunities for pathologist leadership in utilization management, precision medicine, reducing diagnostic errors, and improving health-care outcomes.
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Affiliation(s)
- Barbara S. Ducatman
- Department of Pathology, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI,
USA
| | - Alan M. Ducatman
- Department of Occupational and Environmental Health Sciences, West Virginia
University School of Public Health, Morgantown, WV, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael Laposata
- Department of Pathology, University of Texas Medical Branch, Galveston, TX,
USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University School of
Medicine, Atlanta, GA, USA
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4
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Park JP, Kim SH, Lee S, Yoo SH. Changes in Clinical and Legal Autopsy Rates in Korea from 2001 to 2015. J Korean Med Sci 2019; 34:e301. [PMID: 31808323 PMCID: PMC6900410 DOI: 10.3346/jkms.2019.34.e301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The autopsy is the medical examination of a deceased person that mainly provides information on the cause and manner of death. Two types are conducted in Korea: clinical and legal, depending on its purpose. Despite this procedure's importance, autopsy rates have been decreasing worldwide. The aim of this study was to determine the nationwide autopsy rate in Korea and compare it with that in other countries. METHODS We collected data of autopsies performed between 2001 and 2015 by searching previously published literature on autopsy statistics and by requesting data from the relevant institutions. We calculated the autopsy rate by using mortality data from Statistics Korea; furthermore, we investigated the type of autopsy performed by institution as well as by geographical region. RESULTS The total autopsy rate in Korea increased from 2.16% in 2001 to 2.60% in 2015. In terms of autopsy types, however, clinical autopsy rates decreased from 0.17% in 2001 to 0.03% in 2015, while legal autopsy rates increased from 1.99% to 2.57% during the same period. Moreover, the clinical autopsy rate tended to decrease throughout the period, while the legal autopsy rate fluctuated between 2001 and 2010 but steadily increased thereafter. CONCLUSION The autopsy rate in Korea is lower compared to that of the advanced countries. These findings implicate the need for nationwide policy to promote both clinical and legal autopsy, which remain crucial parts of medical science and public health.
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Affiliation(s)
- Jong Pil Park
- Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sookyoung Lee
- Medical Examiner's Office, National Forensic Service, Wonju, Korea
| | - Seong Ho Yoo
- Institute of Forensic Medicine and Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Latten BGH, Overbeek LIH, Kubat B, Zur Hausen A, Schouten LJ. A quarter century of decline of autopsies in the Netherlands. Eur J Epidemiol 2019; 34:1171-1174. [PMID: 31728879 DOI: 10.1007/s10654-019-00572-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Autopsy rates have been declining worldwide. The present study reports the outcome of a retrospective analysis of all non-forensic autopsies in the Netherlands over a course of 25 years, and compares these with the most recent Dutch study. METHOD Retrospectively, 25 years of data on clinical autopsies from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA) was paired with the mortality registry (Statistics Netherlands). RESULTS The crude prevalence of autopsies declined from 7.07% in 1991 to 2.73% in 2015. After adjusting for age at death, there was no difference in autopsy rate between males and females. An increasing age significantly decreased the autopsy rate. CONCLUSION In the Netherlands, clinical autopsies have been declining over the last quarter century. Age at death, but not sex, was associated with the autopsy rate. These different results stress the importance of correct collection and analysis methods of data.
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Affiliation(s)
- Bartholomeus G H Latten
- Department of Pathology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lucy I H Overbeek
- Donders Center of Medical Neurosciences, Radboud University, Houtlaan 4, 6525 XZ, Nijmegen, The Netherlands
| | - Bela Kubat
- Department of Pathology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Axel Zur Hausen
- Department of Pathology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Leo J Schouten
- Department of Epidemiology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Hasegawa J, Wakasa T, Matsumoto H, Takeuchi M, Kanayama N, Tanaka H, Katsuragi S, Nakata M, Murakoshi T, Osato K, Nakamura M, Sekizawa A, Ishiwata I, Ikeda T. Analysis of maternal death autopsies from the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2017; 31:333-338. [PMID: 28110592 DOI: 10.1080/14767058.2017.1285890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan. METHODS Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed. RESULTS Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy. CONCLUSION Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.
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Affiliation(s)
- Junichi Hasegawa
- a Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kanagawa , Japan
| | - Tomoko Wakasa
- b Department of Diagnostic Pathology , Nara Hospital, Kindai University Faculty of Medicine , Ikoma , Japan
| | - Hiroshi Matsumoto
- c Department of Legal Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Makoto Takeuchi
- d Department of Pathology , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan
| | - Naohiro Kanayama
- e Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Hiroaki Tanaka
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Shinji Katsuragi
- g Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan
| | - Masahiko Nakata
- h Department of Obstetrics and Gynecology , Toho University School of Medicine , Tokyo , Japan
| | - Takeshi Murakoshi
- i Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan
| | - Kazuhiro Osato
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Masamitsu Nakamura
- j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Akihiko Sekizawa
- j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Isamu Ishiwata
- k Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan
| | - Tomoaki Ikeda
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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