Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study.
Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study.
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DOI：
10.1186/s40748-019-0112-x
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Saleem, Sarah
中科院分区：
文献类型：
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作者：
Feroz, Anam;Ali, Anum Shiraz;Saleem, Sarah
背景技术背景：巴基斯坦被认为是世界上分娩风险最高的地方之一，因为其死胎和新生儿死亡率很高。完整的诊断性尸检仍然是确定死因（CoD）的黄金标准;然而，由于宗教反对、社会文化信仰、资源有限以及医生和家人的需求较低，它并没有常规实施。最近，已经开发并推广了微创组织取样（MITS），其使用多个组织的针穿刺活检来获得用于组织学检查和用PCR进行生物体鉴定的组织，以确定低资源地区的CoD。为了确保成功实施MITS，重要的是要了解卫生专业人员的态度和看法MITS.METHODS：一个定性研究进行了国家儿童健康研究所（NICH），卡拉奇，巴基斯坦。与卫生专业人员（包括医生、护士、受训人员、临床医生、生物伦理学专家和公共卫生专家）进行了焦点小组讨论（FGD）和关键知情人访谈（KII），以探讨他们对MITS可接受性的看法和观点。结果：共进行访谈12次，其中功能性疾病4次，关键性疾病8次。确定了四个首要主题：（I）MITS的可接受性;（II）MITS程序的感知效益;（III）促进MITS实施的因素;（IV）实施MITS程序的卫生系统要求。总体而言，医疗保险和医疗支助服务被认为是卫生系统的一个积极发展。诊断准确性和识别不常见的死亡原因被强调为MITS程序的两个主要好处。该研究强调了MITS可接受性的一些促进因素，包括有效的咨询，与父母建立信任，快速的程序时间，以及在死亡后几小时内接近家人。此外，缺乏熟练的工作人员，设备简陋的医疗设施和潜在的高成本进行MITS被确定为实施MITS.CONCLUSIONS的挑战：这种形成性的研究提供了一个独特的机会，探讨卫生专业人员的意见和态度的MITS程序。这些见解对于确保成功实施新技术并将其纳入现有卫生系统至关重要。该研究确定了影响巴基斯坦卫生专业人员接受MITS的因素。该研究还提供了有助于促进在巴基斯坦和类似环境下实施MITS程序的因素。
BACKGROUND: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals' attitudes and perceptions related to MITS.METHODS: A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software.RESULTS: A total of 12 interviews (FGDs=4; KIIs=8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS.CONCLUSIONS: This formative research provided a unique opportunity to explore health professionals' views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.