Knowledge, acceptability, and attitudes regarding minimally invasive tissue sampling (MITS) techniques in Brazil

Journal article

Determining cause of death is fundamental for health services to guide the formulation of appropriate public policies to reduce and prevent mortality. In Brazil, some deaths still do not have their underlying cause defined, and in these cases, performing a complete diagnostic autopsy (CDA) is essential. However, there are challenges that hinder its performance, and in this scenario, minimally invasive tissue sampling (MITS) could be a promising alternative. Here, we explored the knowledge, acceptability, and attitudes towards CDA and MITS in Northeast Brazil. We conducted a cross-sectional study using structured questionnaires that were disseminated using snowball sampling through medical societies networks, social networks, instant messaging groups, and email. Chi-square tests or Fisher’s exact tests were performed, as appropriate, to determine the difference between the five groups (i.e., pathologists, non-pathologist physicians, other health professionals, medical students, and the general population). 1,519 individuals participated, predominantly female (67.9%) with a median age of 41 (range 21 – 83) years. There was widespread recognition of the importance of CDA (79.6%) and a predisposition to authorize it among family members (67.0%). 1.5% reported knowing about MITS, and 83.4% believed that greater publicity for MITS would increase accessibility. Among physicians and pathologists (n = 141), 52.2% agreed that trained professionals could perform the technique, and 79.3% agreed that MITS had a lower cost and required less hands-on time than CDA. Regarding implementation, blood (52.2%) and liver (26.1%) were identified as the easiest organs to sample, while brain (50.0%) and spleen (24.0%) were considered the most technically difficult. Although widely accepted among scholars in the field, MITS is little known outside of this environment. Investments in training, standardization of protocols for consent and conduct, and communication strategies that are sensitive to the sociocultural context are fundamental for its adoption as a complementary tool in determining the cause of death in countries like Brazil.

Authors: Almeida, LM; Melo, DN; Souza, PMMD; Coelho, TMS; Mota, AGDM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Public Library of Science
• Journal: PLOS Global Public Health
• Volume: 6
• Issue: 4
• Pages: e0006147
• Article number: e0006147
• Publication date: 2026-04-13
• Acceptance date: 2026-03-03
• DOI: 10.1371/journal.pgph.0006147
• EISSN: 2767-3375
• ISSN: 2767-3375
• Language: English
• Keywords: Snowball sampling; Sampling (signal processing); Verbal autopsy; Public health; Cause of death; Publicity; Blood sampling