ORIGINAL ARTICLE

Perinatal pathology in the context of a clinical trial: attitudes of neonatologists and pathologists

C Snowdon^1,2, D R Elbourne¹ and J Garcia¹

¹ Medical Statistics Unit, London School of Hygiene and Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK
² Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK

Correspondence to:
Correspondence to:
C Snowdon
Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK; cms1000{at}cam.ac.uk

Objective: To describe the attitudes of neonatologists to trial related perinatal postmortem examinations (PMs), in the light of declining perinatal PM rates and poor levels of participation in pathology studies.

Methods: A qualitative study was carried out, using semistructured interviews. Twenty six neonatologists from five UK neonatal units were interviewed; five UK perinatal pathologists also contributed to the study. The professionals involved were all linked to one or both of two neonatal trials.

Results: Pathologists expressed concern over the difficulties experienced in UK perinatal pathology and the impact on research of inadequate levels of samples. The interviews with neonatologists reveal discomfort over approaching bereaved parents for PMs, and a widespread concern that parents should not be further distressed or feel under pressure to consent. Although there was support for neonatal trials, the study highlights a view that PMs may be unnecessary if the cause of death seems apparent or when a baby was born prematurely, and a devaluation of PMs among some younger staff. Poor rates of participation in pathology studies may be accounted for by a notable sense of disconnection between trial interventions and pathology studies.

Conclusions: Neonatologists were concerned to protect vulnerable parents and varied in whether they saw this as compatible with inclusion in trial related pathology studies. Dedicated research is needed to document and gain an understanding of the consent process and should examine the usefulness and impact of consent forms. It should assess whether professionals might benefit from training, to help parents to come to their decisions.

Keywords: perinatal postmortem examinations; neonatologist; pathologist; attitudes; interview

Abbreviations: PM, postmortem examination; RCT, randomised controlled trial

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