Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis
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CLINICAL INVESTIGATION
OTHER
Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis Eric J. Keller1
•
Rana Rabei2 • Michael Heller2 • Nishita Kothary1
Received: 14 July 2020 / Accepted: 29 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To characterize perceptions of palliative versus futile care in interventional radiology (IR) as a roadmap for quality improvement. Methods Interventional radiologists (IRs) and referring physicians were recruited for anonymous interviews and/or focus groups to discuss their perceptions and experiences related to palliative verse futile care in IR. Sessions were recorded, transcribed, and systematically analyzed using dedicated software, content analysis, and grounded theory. Data collection and analysis continued simultaneously until additional interviews stopped revealing new themes: 24 IRs (21 males, 3 females, 1–39 years of experience) and 7 referring physicians (3 males, 4 females, 6–14 years of experience) were analyzed. Results Many IRs (75%) perceived futility as an important issue. Years of experience (r = 0.60, p = 0.03) and being in academics (r = 0.62, p = 0.04) correlated with greater perceived importance. Perceptions of futility and whether a potentially inappropriate procedure was performed involved a balance between four sets of factors (patient, clinician, procedural, and cultural). These assessments tended to be qualitative in nature and are challenged by a lack of data, education, and consistent workflows. Referring clinicians were unaware of this issue and assumed IR
& Eric J. Keller [email protected] 1
Department of Radiology, Stanford University, Stanford, 300 Pasteur Drive, H3630, Stanford, CA 94305, USA
2
Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M-391, San Francisco, CA 94143, USA
had guidelines for differentiating between palliation and futility. Conclusion This study characterized the complexity and qualitative nature of assessments of palliative verses futile care in IR while highlighting potential means of improving current practices. This is important given the number of critically ill patients referred to IR and costs of potentially inappropriate interventions. Keywords Futility Interventional radiology Potentially inappropriate procedure Perceptions Palliative care
Introduction Interventional radiologists (IRs) often care for critically ill patients [1, 2], and there are numerous ways interventional radiology (IR) can positively contribute to the care of these patients [3, 4]. However, these procedures can have significant financial and non-financial costs [5], challenging clinicians, patients, families, and payers to consider when an intervention will truly benefit a patient. Medical interventions that are highly unlikely to provide meaningful benefit are often described as ‘‘futile.’’ This contrasts with ‘‘palliativ
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