Authors: Alex K Williamson MD & Meagan Chambers MD
Holding a family meeting to discuss autopsy findings is one of the most rewarding aspects of postmortem care. It is incredibly important for the family members and offers a unique and visible way for pathologists to come out of the lab and exert their value in today’s healthcare setting.
The key to a productive family meeting is competent autopsy performance and reporting. Family meetings should only be scheduled after the report is finalized.
The clinician of record should always be invited to engage in family meetings. It’s appropriate to talk to the clinician, explain the family has requested a meeting to discuss the autopsy findings, and invite the clinician to engage in the meeting. Some will engage and some will not. All you have to do is ask.
The resident pathologist should attend the family meeting, as well.
Suggested agenda and guidance for family meetings to review autopsy report
Preparation
- Review and become (re)familiar with the case history and autopsy report
- Plan for the meeting to last 30-60 minutes
- If holding the meeting in person, arrange for a quiet place where you will not be disturbed; have water and Kleenex accessible
- If holding the meeting over the telephone, close your door with a “do not disturb” sign on its external side
Opening
- Introduce all professionals and their roles (e.g., clinician, attending, resident, etc.)
- Express your condolences
- Ask family how they prefer you reference the decedent (i.e., first name, formal name) and subsequently address the decedent in the preferred manner
Orientation to autopsy report
- Provide brief overview of autopsy report structure* (i.e., in person, flip through the pages as you discuss them; over telephone, ask the family to follow along, citing page numbers as you discuss them)
- Findings and diagnoses, which documents all pathology and places it into clinical context
- Autopsy summary, which summarizes the important findings and puts them into clinical context
- Cause of death statement, based on clinical AND autopsy findings
- Clinical summary, which provides brief overview of the medical record
- Gross description, which documents the body examination findings
- Microscopic description, which documents what was seen in tissue biopsies examined under the microscope
- Quality assurance, which also places the autopsy results into clinical context
- Neuropathology, which documents examination and findings in the brain (and spine)
Review of clinical course and autopsy report
- Briefly summarize the decedent’s clinical course (clinician should do this if present)
- If the clinician is not a part of the conversation, focus on pathology and clinical pathologic correlation; do not comment on appropriateness of clinical care
- Go through the various diagnoses, trying to put them into understandable terminology. For example:
- “The heart muscle was enlarged because it was pumping against high blood pressure”
- “The coronary arteries were significantly blocked by atherosclerosis, which prevented adequate blood flow including oxygen from reaching the heart muscle”
- “The kidneys were scarred due to the effects of high blood pressure and diabetes mellitus, which interfered with their function”
- Summarize the main cause of death sequence and factors contributing to death
Closing
- Ask if the family has any questions and address them
- Remind the family they can take time to review the report and then follow up with you at a later time with additional questions
- Thank the family for consenting to the autopsy
- It allowed the decedent to share his or her story
- It hopefully will help bring closure to the family
After the meeting
- Thank the clinician for engaging in postmortem care
- Document the meeting in the decedent’s medical record and/or an addendum to the autopsy report
- Date, time, location (or virtual)
- Attendees
- BRIEF overview of what was discussed (i.e., “Clinical course and autopsy findings reviewed; family questions answered; family directed to follow up with NAME with any further questions.”)
Autopsy Admin or Lead Pathologists’ assistant can assist you in creating the addendum to the autopsy report documenting the family meeting.
Enjoy engaging in postmortem care!
For additional resources, see the NAME Best Practice Recommendations for Communicating with next of Kin During Medicolegal Death Investigations
