Table 4

Quotes illustrating implementation issues and likely uptake of less invasive autopsy

ThemeIllustrative quotes
 Skills and trainingI’m assuming one of our radiologists would need to have a particular interest in this and would need to be happy to take this on as a particular interest… You need somebody who gets used to looking at them, but whether any of our radiologists have got the will to have an interest in this and to help develop this as a service, that’s something that would need exploring, if it was going to be rolled out. Obstetrician 1
I think for some pathologists they’re put off by, you know, trying to use a tiny telescope and just having very minimal access. I think as pathologists we’re used to doing large incisions and dissecting organs… practice changes I suppose this is kind of an extension of that really, just applying it at a post-mortem practice. Paediatric pathologist 1
 LogisticsI would say that it would be good practice probably for the pathologists and radiologists to look at the images together because the pathologists would have looked at the baby and perhaps may have some other information, might have the clinical history and the radiologist would look at the image…I’d say it’s best done as a joint type of endeavour. Obstetrician 3
Personally I think it would be a very, very, very good thing and there’d be lots of advantages but I don’t see it happening for the next ten years unfortunately because of the NHS infrastructure. For example, you need new electronics, broadband, you’ve got to have a wide bandwidth to transmit digital images as well because you might send these images to experts. Paediatric pathologist 1
 Cost implications and equity of accessIt might be something that only happens in five or six centres around the UK. Radiologist 1
You need the space to house a scanner. Can you afford it? Can you afford the staff that’s needed? That’s really the block to wide spread development. Coroner 1
I would be far, far happier…if it was advertised to everyone, to take away from this being only for faith groups. Coroner 1
Acceptance and governanceSo I think firstly we need to generate that evidence that MR autopsy is as good and then it would need to gain acceptance within the pathology community and when that has happened I think we would need to do a lot of education of obstetricians and midwives to show that this was a more effective and more acceptable, you know, alternative to a full autopsy. Obstetrician 3
I suppose there is always a certain amount of ‘oh, we’ve always done it this way and it works for us’. Paediatric pathologist 2
Reconfiguring a service would require a lot of resources and my reflection is it would be a bit of a difficult sell to a management, which I think understandably is very preoccupied about things like the numbers of people coming through the door of A&E [Accident and Emergency] and whether we could get them a bed that night. Paediatric pathologist 2
There has been resistance by some Coroners in some areas not least because we haven’t been given much in the way of guidance or information from those who are in a position to understand the science. Coroner 3
Likely uptake
I think it would be very attractive for parents who don’t want the incision across the head, the Y incision and no, absolutely I think it would be a much larger uptake. Bereavement midwife 3
So pretty much people split into ‘do whatever you need to do doc, we need to find out what happened here’ versus ‘you can’t touch my baby’ and there’s just a few in the middle, you know, so you might adjust the margins somewhat. Consultant ICU 4
I can certainly think of quite a number of people that you know it was like ‘no, no, no’ no to the full post mortem and then you would say ‘well, actually there is this that we can offer’ and that they would agree to that. Bereavement midwife 1
At the moment it’s very much, you know, do you want to the whole autopsy or nothing…So I wonder whether one of the ways that this could change is it wouldn’t be an all or nothing, you could say to parents ‘we will stop at the point at which you tell us and when we get an answer we stop looking’. Obstetrician 3