Exploring Perceptions and Acceptance of Minimally Invasive Tissue Sampling among Bereaved Relatives and Health-Care Professionals in Rwanda

Abstract

Purpose In most low- and lower middle-income countries (LMICs), minimally invasive tissue sampling (MITS) is a relatively new procedure for identifying the cause of death (CoD). This study aimed to explore perceptions and acceptance of bereaved families and health-care professionals regarding MITS in the context of MITS initiation in Rwanda as an alternative to clinical autopsy. Methods This was a qualitative phenomenological study with thematic analysis. Participants were bereaved relatives (individual interviews) and health-care professionals (focus-group discussions) involved in MITS implementation. It was conducted in the largest referral and teaching hospital in Rwanda. Results Motivators of MITS acceptance included eagerness to know the CoD, noninvasiveness of MITS, trust in medics, and the fact that it was free. Barriers to consent to MITS included inadequate explanations from health-care professionals, high socioeconomic status, lack of power to make decisions, and lack of trust in medics. Health-care professionals perceived both conventional autopsy and MITS as gold-standard procedures in CoD determination. They recommended including MITS among hospital services and commended the post-MITS multidisciplinary discussion panel in CoD determination. They pointed out that there might be reticence in approaching bereaved relatives to obtain consent for MITS. Both groups of participants highlighted the issue of delay in releasing MITS results. Conclusion Both health-care professionals and bereaved relatives appreciate that MITS is an acceptable procedure to include in routine hospital services. Dealing with barriers met by either group is to be considered in the eventual next phases of MITS implementation in Rwanda and similar sociocultural contexts.

Knowledge and attitudes toward complete diagnostic autopsy and minimally invasive autopsy: A cross-sectional survey in Hanoi, Vietnam

“…Regarding MIA, findings from many studies agreed with our findings that it could be useful to identify CoD. For studies among the general population, and for participants who had not heard of the method but had the procedure explained, they believed it could help to establish accurate CoD [20,23,24]. The minimally invasive nature of MIA was also considered a factor for people to prefer MIA over CDA, especially in studies of bereaved relatives.…”

“…The minimally invasive nature of MIA was also considered a factor for people to prefer MIA over CDA, especially in studies of bereaved relatives. Bereaved respondents from a study in Rwanda agreed that one of the advantages of MIA was that it did not deform or alter the body while still being able to determine CoD [23]. Expanding upon our survey's finding, this study also added that CoD identifed by MIA can prevent family conflict and dispute among community members.…”

A Qualitative Assessment of Community Acceptability and Its Determinants in the Implementation of Minimally Invasive Tissue Sampling in Children in Quelimane City, Mozambique

“…4,7 This technique is being used in several contexts in LMICs and appears to be promising in terms of its greater acceptability because it is considered a fast, simple, and more user-friendly technique that can be performed by minimally trained staff, although there are factors considered to be important barriers that may put its acceptability at risk. [9][10][11] Existing evidence on the anticipated and experienced acceptability of the MITS procedure thus demonstrates the importance of recognizing the cultural mores and practices of the context where MITS is implemented. 9,12 Death and related post-mortem procedures are embedded in complex social, cultural, and religious environments.…”

“…[9][10][11] Existing evidence on the anticipated and experienced acceptability of the MITS procedure thus demonstrates the importance of recognizing the cultural mores and practices of the context where MITS is implemented. 9,12 Death and related post-mortem procedures are embedded in complex social, cultural, and religious environments. 9,10 In the case of Zamb ezia province (central Mozambique), the existence of myths, rumors, and negative perceptions of certain public health initiatives, as was the case with cholera control, 13 could challenge the success of the implementation of MITS in this setting.…”

“…9,12 Death and related post-mortem procedures are embedded in complex social, cultural, and religious environments. 9,10 In the case of Zamb ezia province (central Mozambique), the existence of myths, rumors, and negative perceptions of certain public health initiatives, as was the case with cholera control, 13 could challenge the success of the implementation of MITS in this setting. Acknowledging this risk, it is critical to understand local attitudes and perceptions in relation to death as well as the potential barriers and facilitators to the uptake of interventions involving post-mortem procedures, which could determine the acceptability of the implementation of MITS in Quelimane.…”