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

Area of Science:

• Medical Imaging and Interventional Radiology
• Healthcare Quality Improvement
• Medical Ethics

Background:

• Distinguishing between palliative and futile care in interventional radiology (IR) is crucial for quality improvement.
• Critically ill patients often undergo interventions in IR, necessitating clear guidelines on care appropriateness.
• Current practices lack standardized approaches, leading to potential inconsistencies.

Purpose of the Study:

• To characterize interventional radiologists' and referring physicians' perceptions of palliative versus futile care in IR.
• To identify challenges and opportunities for quality improvement in differentiating care types within IR.
• To inform the development of better guidelines and workflows for IR procedures.

Main Methods:

• Anonymous interviews and focus groups were conducted with 24 interventional radiologists and 7 referring physicians.
• Systematic content analysis and grounded theory were applied to transcribed session data.
• Data collection and analysis proceeded until thematic saturation was reached.

Main Results:

• 75% of interventional radiologists viewed futility as a significant issue, with experience and academic roles correlating with higher perceived importance.
• Assessments of futility involve complex qualitative factors (patient, clinician, procedural, cultural) and are hindered by data and education deficits.
• Referring physicians were largely unaware of the complexities and assumed IR had established guidelines for palliative vs. futile care.

Conclusions:

• The assessment of palliative versus futile care in IR is complex and qualitative, requiring attention for practice improvement.
• Addressing a lack of data, education, and consistent workflows is essential for enhancing care quality in IR.
• Recognizing and standardizing the distinction between palliative and futile interventions in IR is vital for optimizing patient outcomes and resource allocation.