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Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis

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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 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.

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Acknowledgements

This work was supported by the Society of Interventional Radiology’s and Society of Interventional Oncology’s Applied Ethics Working Groups.

Funding

This study was funded by Stanford’s Division of Interventional Radiology.

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Authors and Affiliations

  1. Department of Radiology, Stanford University, Stanford, 300 Pasteur Drive, H3630, Stanford, CA, 94305, USA

    Eric J. Keller & Nishita Kothary

  2. Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143, USA

    Rana Rabei & Michael Heller

Authors
  1. Eric J. Keller
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  2. Rana Rabei
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  3. Michael Heller
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  4. Nishita Kothary
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Correspondence to Eric J. Keller.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

This study has obtained IRB approval from Stanford University IRB Panel 61, and the need for informed consent was waived.

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Consent for publication was obtained for every individual person’s data included in the study.

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Keller, E.J., Rabei, R., Heller, M. et al. Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis. Cardiovasc Intervent Radiol 44, 127–133 (2021). https://doi.org/10.1007/s00270-020-02675-3

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  • DOI: https://doi.org/10.1007/s00270-020-02675-3

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