- ABSTRACT.
- INTRODUCTION
- MATERIALS AND METHODS
- STATISTICAL ANALYSES
- RESULTS
- Participant characteristics.
- Self-rated competence and knowledge of HCWs regarding obtaining informed consent for autopsy.
- Practices of HCWs regarding obtaining informed consent for autopsy.
- Relationship between evaluated competence and knowledge in obtaining informed consent for autopsy.
- Factors associated with high competence scores.
- DISCUSSION
- CONCLUSION
- ACKNOWLEDGMENT
- REFERENCES
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Alfsen GC , Mæhlen J , 2012. The value of autopsies for determining the cause of death. Tidsskr Nor Laegeforen 132: 147–151.
-
2.
Das A , Chowdhury R , 2017. Searching cause of death through different autopsy methods: A new initiative. J Family Med Prim Care 6: 191–195.
-
3.
Bassat Q et al., 2013. Development of a post-mortem procedure to reduce the uncertainty regarding causes of death in developing countries. Lancet Glob Health 1: e125–e126.
-
4.
Cox JA , Lukande RL , Kateregga A , Mayanja-Kizza H , Manabe YC , Colebunders R , 2011. Autopsy acceptance rate and reasons for decline in Mulago Hospital, Kampala, Uganda. Trop Med Int Health 16: 1015–1018.
-
5.
Bunei M , Muturi P , Otiato F , Njuguna HN , Emukule GO , Otieno NA , Dawa J , Chaves SS , 2019. Factors influencing acceptance of post-mortem examination of children at a tertiary care hospital in Nairobi, Kenya. Ann Glob Health 85.
-
6.
Namuju OC , Kwizera R , Lukande R , Pastick KA , Taylor JM , Nicol MR , Boulware DR , Meya DB , 2021. Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda. Wellcome Open Res 6: 302.
-
7.
Blum LS , Karia FP , Msoka EF , Oshosen Mwanga M , Crump JA , Rubach MP , 2020. An in-depth examination of reasons for autopsy acceptance and refusal in northern Tanzania. Am J Trop Med Hyg 103: 1670–1680.
-
8.
Odendaal HJ , Elliott A , Kinney HC , Human M , Gaspar D , Petersen D , Randall B , Dempers J ; Prenatal Alcohol and SIDS and Stillbirth (PASS) Network , 2011. Consent for autopsy research for unexpected death in early life. Obstet Gynecol 117: 167–171.
-
9.
Oluwasola OA , Fawole OI , Otegbayo AJ , Ogun GO , Adebamowo CA , Bamigboye AE , 2009. The autopsy: Knowledge, attitude, and perceptions of doctors and relatives of the deceased. Arch Pathol Lab Med 133: 78–82.
-
10.
Lewis C , Hill M , Arthurs OJ , Hutchinson C , Chitty LS , Sebire NJ , 2018. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 125: 172–181.
-
11.
Lamont S , Stewart C , Chiarella M , 2019. Capacity and consent: Knowledge and practice of legal and healthcare standards. Nurs Ethics 26: 71–83.
-
12.
Strini V , Schiavolin R , Prendin A , 2021. The role of the nurse in informed consent to treatments: An observational-descriptive study in the Padua Hospital. Clin Pract 11: 472–483.
-
13.
Convie LJ , Carson E , McCusker D , McCain RS , McKinley N , Campbell WJ , Kirk SJ , Clarke M , 2020. The patient and clinician experience of informed consent for surgery: A systematic review of the qualitative evidence. BMC Med Ethics 21: 58.
-
14.
Shah P , Thornton I , Turrin D , Hipskind JE , 2023. Informed Consent. Treasure Island, FL: StatPearls Publishing LLC.
-
15.
Guyer PJ , 2003. Kant on the theory and practice of autonomy. Soc Philos Policy 20: 70–98.
-
16.
Varkey B , 2021. Principles of clinical ethics and their application to practice. Med Princ Pract 30: 17–28.
-
17.
Pietrzykowski T , Smilowska K , 2021. The reality of informed consent: Empirical studies on patient comprehension-systematic review. Trials 22: 57.
-
18.
Jahan F , Roshan R , Nanji K , Sajwani U , Warsani S , Jaffer S , 2014. Factors affecting the process of obtaining informed consent to surgery among patients and relatives in a developing country: Results from Pakistan. East Mediterr Health J 20: 569–577.
-
19.
Nijhawan LP , Janodia MD , Muddukrishna BS , Bhat KM , Bairy KL , Udupa N , Musmade PB , 2013. Informed consent: Issues and challenges. J Adv Pharm Technol Res 4: 134–140.
-
20.
Nzaumvila D , Ntotolo P , Govender I , Lukanu P , Niati JL , Sanduku D , Bongongo T , 2021. Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo. Afr Health Sci 21: 478–488.
-
21.
Negash W , Assefa N , Baraki N , Wilfong T , 2021. Practice and factors associated with informed consenting process for major surgical procedures among health-care workers, south eastern Ethiopia. Int J Gen Med 14: 7807–7817.
-
22.
Rosenbaum GE , Burns J , Johnson J , Mitchell C , Robinson M , Truog RD , 2000. Autopsy consent practice at US teaching hospitals: Results of a national survey. Arch Intern Med 160: 374–380.
-
23.
Williams AT , Morris D , Patel NK , 2002. Pathologists’ views on consent for autopsy. J R Soc Med 95: 547–548.
-
24.
Xing H , Zhu S , Liu S , Xia M , Jing M , Dong G , Ni W , Li L , 2022. Knowledge, attitudes and practices of ICU nurses regarding subsyndromal delirium among 20 hospitals in China: A descriptive cross-sectional survey. BMJ Open 12: e063821.
-
25.
Kruger J , Dunning D , 1999. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 77: 1121–1134.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 303 | 303 | 69 |
| Full Text Views | 22 | 22 | 3 |
| PDF Downloads | 23 | 23 | 3 |
Self-Rated Competence of Ugandan Healthcare Workers to Obtain Informed Consent for Autopsy
Felix Bongomin
Felix Bongomin
Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda;
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Winnie Kibone
Winnie Kibone
Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda;
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Ritah Nantale
Ritah Nantale
Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda;
Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda;
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Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda;
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Robert Lukande
Robert Lukande
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda;
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Ruth Bromley
Ruth Bromley
Ethics and Law, Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom;
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Conrad Muzoora
Conrad Muzoora
Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;
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Davidson H. Hamer
Davidson H. Hamer
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Disease Laboratory, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
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Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Disease Laboratory, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
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ABSTRACT.
We examined the self-rated competence of Ugandan healthcare workers (HCWs) in obtaining informed consent for autopsies, considering the challenges of low autopsy acceptance rates globally. In September and October 2023, we conducted a nationwide cross-sectional study of HCWs, who provided informed consent to participate and completed an online, self-administered questionnaire. Participants’ self-rated competence in obtaining informed consent for autopsy was assessed through Likert scale questions. Knowledge and practices were also assessed. All scores were converted to percentages, with scores ≥80% indicating higher competence. We enrolled 216 HCWs (including 145 [67.1%] doctors), with a mean age of 31.6 ± 7.2 years. Overall, 55.6% (n = 120) had ever assisted in obtaining consent for autopsy, 43.6% (n = 100) had ever obtained consent for autopsy themselves, and 13.4% (n = 29) had ever attended training on obtaining consent for autopsy. The mean competency score was 59.8 ± 17.0% (perfect score, 100%), with 29 (13.4%) participants demonstrating high competence. Healthcare workers with adequate knowledge had higher competence scores (odds ratio [OR]: 15.0, 95% CI: 6.17–36.58, P <0.001). Compared with nurses/midwives, doctors had 73% lower odds of having a high competence score (adjusted OR: 0.27, 95% CI: 0.08–0.94, P = 0.040). Fewer than one in five Ugandan HCWs demonstrated high self-rated competence or possessed adequate knowledge regarding informed consent for autopsies, and only a few had received specialized training on how to obtain consent for an autopsy. Therefore, there is a pressing need for enhanced training and increased awareness among Ugandan HCWs in obtaining informed consent for autopsies.
Author Notes
Financial support: Research reported in this publication was supported by the
Disclosures: Consent for publication was obtained from all study participants during the process of obtaining informed consent to participate in the study. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. All relevant data are within the article and its supporting information files. Data are available upon reasonable request from the first author. The study protocol was approved by the Gulu University Research and Ethics Committee (#GUREC-2023-635). Informed consent was sought from all participants. Ethical regulations outlined in the Declaration of Helsinki were observed throughout the study. Anonymity was guaranteed during data collection to ensure confidentiality and encourage honest responses. No hospital- or participant-identifiable information beyond basic demographics was requested.
Current contact information: Felix Bongomin and Winnie Kibone, Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda, E-mails: drbongomin@gmail.com and kibonewinnie@gmail.com. Ritah Nantale, Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda, and Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda, E-mail: ritahclaire24@gmail.com. Robert Lukande, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda, E-mail: slylukas@gmail.com. Ruth Bromley, Ethics and Law, Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom, E-mail: ruth.bromley@manchester.ac.uk. Conrad Muzoora, Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda, E-mail: conradmuzoora@yahoo.com. Davidson H. Hamer, Department of Global Health, Boston University School of Public Health, Boston, MA, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA, and Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, MA, E-mail: dhamer@bu.edu.
- ABSTRACT.
- INTRODUCTION
- MATERIALS AND METHODS
- STATISTICAL ANALYSES
- RESULTS
- Participant characteristics.
- Self-rated competence and knowledge of HCWs regarding obtaining informed consent for autopsy.
- Practices of HCWs regarding obtaining informed consent for autopsy.
- Relationship between evaluated competence and knowledge in obtaining informed consent for autopsy.
- Factors associated with high competence scores.
- DISCUSSION
- CONCLUSION
- ACKNOWLEDGMENT
- REFERENCES
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Alfsen GC , Mæhlen J , 2012. The value of autopsies for determining the cause of death. Tidsskr Nor Laegeforen 132: 147–151.
-
2.
Das A , Chowdhury R , 2017. Searching cause of death through different autopsy methods: A new initiative. J Family Med Prim Care 6: 191–195.
-
3.
Bassat Q et al., 2013. Development of a post-mortem procedure to reduce the uncertainty regarding causes of death in developing countries. Lancet Glob Health 1: e125–e126.
-
4.
Cox JA , Lukande RL , Kateregga A , Mayanja-Kizza H , Manabe YC , Colebunders R , 2011. Autopsy acceptance rate and reasons for decline in Mulago Hospital, Kampala, Uganda. Trop Med Int Health 16: 1015–1018.
-
5.
Bunei M , Muturi P , Otiato F , Njuguna HN , Emukule GO , Otieno NA , Dawa J , Chaves SS , 2019. Factors influencing acceptance of post-mortem examination of children at a tertiary care hospital in Nairobi, Kenya. Ann Glob Health 85.
-
6.
Namuju OC , Kwizera R , Lukande R , Pastick KA , Taylor JM , Nicol MR , Boulware DR , Meya DB , 2021. Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda. Wellcome Open Res 6: 302.
-
7.
Blum LS , Karia FP , Msoka EF , Oshosen Mwanga M , Crump JA , Rubach MP , 2020. An in-depth examination of reasons for autopsy acceptance and refusal in northern Tanzania. Am J Trop Med Hyg 103: 1670–1680.
-
8.
Odendaal HJ , Elliott A , Kinney HC , Human M , Gaspar D , Petersen D , Randall B , Dempers J ; Prenatal Alcohol and SIDS and Stillbirth (PASS) Network , 2011. Consent for autopsy research for unexpected death in early life. Obstet Gynecol 117: 167–171.
-
9.
Oluwasola OA , Fawole OI , Otegbayo AJ , Ogun GO , Adebamowo CA , Bamigboye AE , 2009. The autopsy: Knowledge, attitude, and perceptions of doctors and relatives of the deceased. Arch Pathol Lab Med 133: 78–82.
-
10.
Lewis C , Hill M , Arthurs OJ , Hutchinson C , Chitty LS , Sebire NJ , 2018. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 125: 172–181.
-
11.
Lamont S , Stewart C , Chiarella M , 2019. Capacity and consent: Knowledge and practice of legal and healthcare standards. Nurs Ethics 26: 71–83.
-
12.
Strini V , Schiavolin R , Prendin A , 2021. The role of the nurse in informed consent to treatments: An observational-descriptive study in the Padua Hospital. Clin Pract 11: 472–483.
-
13.
Convie LJ , Carson E , McCusker D , McCain RS , McKinley N , Campbell WJ , Kirk SJ , Clarke M , 2020. The patient and clinician experience of informed consent for surgery: A systematic review of the qualitative evidence. BMC Med Ethics 21: 58.
-
14.
Shah P , Thornton I , Turrin D , Hipskind JE , 2023. Informed Consent. Treasure Island, FL: StatPearls Publishing LLC.
-
15.
Guyer PJ , 2003. Kant on the theory and practice of autonomy. Soc Philos Policy 20: 70–98.
-
16.
Varkey B , 2021. Principles of clinical ethics and their application to practice. Med Princ Pract 30: 17–28.
-
17.
Pietrzykowski T , Smilowska K , 2021. The reality of informed consent: Empirical studies on patient comprehension-systematic review. Trials 22: 57.
-
18.
Jahan F , Roshan R , Nanji K , Sajwani U , Warsani S , Jaffer S , 2014. Factors affecting the process of obtaining informed consent to surgery among patients and relatives in a developing country: Results from Pakistan. East Mediterr Health J 20: 569–577.
-
19.
Nijhawan LP , Janodia MD , Muddukrishna BS , Bhat KM , Bairy KL , Udupa N , Musmade PB , 2013. Informed consent: Issues and challenges. J Adv Pharm Technol Res 4: 134–140.
-
20.
Nzaumvila D , Ntotolo P , Govender I , Lukanu P , Niati JL , Sanduku D , Bongongo T , 2021. Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo. Afr Health Sci 21: 478–488.
-
21.
Negash W , Assefa N , Baraki N , Wilfong T , 2021. Practice and factors associated with informed consenting process for major surgical procedures among health-care workers, south eastern Ethiopia. Int J Gen Med 14: 7807–7817.
-
22.
Rosenbaum GE , Burns J , Johnson J , Mitchell C , Robinson M , Truog RD , 2000. Autopsy consent practice at US teaching hospitals: Results of a national survey. Arch Intern Med 160: 374–380.
-
23.
Williams AT , Morris D , Patel NK , 2002. Pathologists’ views on consent for autopsy. J R Soc Med 95: 547–548.
-
24.
Xing H , Zhu S , Liu S , Xia M , Jing M , Dong G , Ni W , Li L , 2022. Knowledge, attitudes and practices of ICU nurses regarding subsyndromal delirium among 20 hospitals in China: A descriptive cross-sectional survey. BMJ Open 12: e063821.
-
25.
Kruger J , Dunning D , 1999. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 77: 1121–1134.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 303 | 303 | 69 |
| Full Text Views | 22 | 22 | 3 |
| PDF Downloads | 23 | 23 | 3 |