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38 Chapter 3 the bereaved with a separate questionnaire on this matter, which they had to fill out themselves immediately after the loss of a loved one. Thus the next-of-kin were not aware that their answers to questions of the doctor were collected to investigate their reasons for allowing or refusing an autopsy. This approach was considered acceptable because the questionnaire (S1 Fig), designed in consultation with the clinicians, was only meant for guidance and documentation of the conversation that clinicians at Erasmus MC normally have with next-of-kin upon demise of a patient. As alluded to above, before starting the survey, we had some clinicians test the preliminary version of the questionnaire, which we adjusted according to their comments, before finalizing and implementing it. To boost clinicians’ compliance, we presented the study at their research meetings, explaining them the purpose of the study, and how to they should use the questionnaire to document their conversation with the next-of-kin. During the survey we reminded them of the study, by giving a second round of presentations. Also, as a standing reminder for the clinicians, we had the questionnaires added to the compulsory forms to be completed upon demise of a patient. From January 2012 to April 2013, questionnaires were collected from1000 consecutive cases. Only patients who had died in-hospital from a supposed natural cause of death were eligible. Excluded were all deceased under age 18, those who underwent euthanasia, and victims of traffic accidents and crime. Case inclusion was based on the mortuary logbook, in which all in-hospital deceased patients are registered. As mentioned consent from next-of-kin for this study was not obtained, therefore, all patient information was anonymized and de-identified prior to analysis. Approval of the Erasmus MC Institutional Review Board and Ethics Committee was obtained for this purely observational study. Data collection For each case we collected information on the consent process, the patients’ characteristics and clinical factors. The information provided in the questionnaires was checked, and if possible, missing data was retrieved from the electronic patient record (EPR). If nonetheless the information was insufficient, or unclear, the clinicians were contacted as soon as possible. In general they appeared very co-operative in providing the missing data. A number of potentially relevant variables, partially based on the literature, 32 was selected for registration in this study: patient characteristics (sex, age, ethnicity, religion, marital status) and clinical aspects, such as being a donor, the ward where the