1226 Factors influencing consent for autopsies for compensation purposes amongst south african miners

Abstract

Introduction Statutory, autopsy-based compensation for occupational lung diseases for South African miners began 100 years ago. Cardio-respiratory organs are removed locally where miners die, regardless of the clinical cause of death and with written consent from a near relative. The organs are examined at the National Institute for Occupational Health in Johannesburg. Previous studies in many countries have shown that the process of obtaining consent is a major determinant of autopsy uptake. Mines provide organ removal services for mineworkers who die while employed. We determined uptake and explored experiences and perceptions of personnel involved in obtaining autopsy consent. Methods A sequential mixed-methods study was conducted. The proportion of miners who died and had an autopsy was determined for three mines (2009 to 2012). Fourteen in-depth interviews were conducted among personnel involved in obtaining autopsy consent in the three mines. Thematic content analysis was applied. Results Average autopsy uptake was 34% in the platinum mine, and 12% and 86% in the two gold mines. Procedures for obtaining consent were similar. The categories of personnel involved in the process included human resource officers, nurses, prosectors and union officials. Barriers to the offering of autopsies were the location of death (consent was less likely to be offered if deaths occurred far from the mines), lack of awareness and poor knowledge and interpretation of the law governing compensation, work load and distrust of the inefficient compensation system. Enablers included sensitivity in communication (empathy, confidentiality, language and culture) and involvement of union officials. Discussion Autopsy uptake was variable across the mining population and was influenced by several individual, sociocultural and institutional factors. Training is required to ensure that personnel who request consent are knowledgeable about the processes and benefits of autopsy compensation, and that they use appropriate communication strategies when talking to families.