Patient-centric care: Recognising the value of non-clinical intervention

During the Society of Interventional Oncology (SIO) 2023 annual scientific meeting in Washington DC, USA, a panel of speakers delivered presentations on why patient-centred care is important, and how to provide it most effectively. The session comprised perspectives beyond interventional radiology—a nurse practitioner and a patient offered complementary and valuable insight—yet there were commonalities across the different presenters’ talks. All emphasised how crucial open communication between the patient and their family and healthcare professionals is. Only with this approach will patients receive the best care, which extends beyond clinical intervention to incorporate caring for the emotional and mental needs of the patient and their loved ones—this was a key takeaway from the session.

Physicians are co-narrators in the patient’s story

Eric Keller (Stanford University, Stanford, USA), whose presentation was delivered in his absence by Isabel Newton (University of California San Diego, San Diego, USA), underlined how “there is more to healing than what we do with our catheters and our wires”. Keller conveyed that “patients’ perspectives of the quality of our work has a lot to do with […] how nice the facility is, our body language, tone of voice and [whether] they can get hold of you for questions and concerns”. Therefore, how a patient feels their experience with a healthcare practitioner has gone is influenced by how it is framed— Keller gave the example of how it is better to tell a patient their biliary drain will be in for a year and for it to come out after six months, than it is to overpromise that it will in three months.

Keller published a study in 2018 in the Journal of Vascular and Interventional Radiology (JVIR), the presenter went on to share, which illustrated that physicians’ and patients’ perceptions of the quality of their care depend on different variables. “[Interventional radiologists] valued minimising side effects and complications,” Keller averred, whereas from the patient’s point of view it is “not so much the actual outcome as much as not being surprised [by it]”. With this in mind, Keller wished to inform delegates that a physician’s role is as a “co-narrator” who seeks to “understand [the patient’s] story” and to help them “write those next few pages”.

Keller then put forward “three important non-procedural interventions that we can do to help maximise our patients’ experiences”. The first was advanced care planning, comprising an assessment of the patient’s goals and preferences for their care. The recommendation is “to facilitate this at the beginning of serious disease”, with scope to revise in line with the patient changing their mind, the presenter relayed. “It does not have to be us [who has these conversations],” Keller continued, “but we can

Merits of splenectomy versus embolization for trauma patients up for debate

advocate for them to occur as part of the preprocedural work-up”.

The second recommendation from Keller was to share alternatives to clinical interventions, to move away from what the presenter dubbed “old-school paternalism”. He made the point that “often we do a great job at discussing our interventions but not at doing the procedure. We are also inconsistent in how we handle preprocedure [‘do not resuscitate’] DNR orders.” As a remedy, the presenter suggested that these are dealt with “well ahead of time”.

Finally, Keller emphasised that “healing is a multifactorial process—it can be easy to forget the impact of nutrition, spirituality and social determinants of health [including] the patient’s socioeconomic status, living situation, race, etc.” Detailing that physicians tend to be sceptical of alternative modes of treatment, Keller vouched for talking to patients about their use of these so as to be more “inclusive”. The concluding note was that interventional radiologists should put a greater emphasis on the precise context in which a patient is being cared for—which is shaped by the aforementioned social factors. Examples of how to maximise these contextual aspects of cancer care, according to Keller, include advanced care planning, shared decision-making, and engaging patients about other aspects of their healing to become co-narrators with patients.

Multidisciplinary interventions make a difference

The second presenter was Angela Laffan, a nurse practitioner based at the University of California San Francisco (San Francisco, USA), who runs a survivorship programme for patients who have finished treatment with curative intent. “Cancer survivorship is to help optimise patients’ overall wellness,” she outlined for the audience. She works primarily with patients with metastatic

Splenic trauma and how best to treat it was the subject of debate at the British Society of Interventional Radiology (BSIR) annual scientific meeting (2–4 November, Glasgow, UK). Presenting their contrasting takes on the topic were Warren Clements (The Alfred Hospital, Melbourne, Australia), who argued that “embolization is best for the patient” and Morgan McMonagle (St Mary’s Hospital and Imperial College, both London, UK), whose opinion was that “splenectomy is best for the [haemodynamically unwell] patient”.

CLEMENTS WAS UP FIRST, SETTING the scene for the debate by explaining that the spleen is a “very commonly injured organ” as it is “mobile”, and therefore susceptible to puncture, for example as a result of a rib fracture. Mortality following splenic trauma is high, Clements then noted, but embolization can allow preservation of the spleen through a simple minimally invasive pinhole treatment. The presenter outlined his preferred method for splenic artery embolization: proximally “to reduce direct flow or blood pressure at the spleen”, while allowing it to “[remain] perfused by collateral vessels”. In terms of materials, Clements put forward gel, coils, and plugs as options, but emphasised that pushable coils in particular are “nice and cheap and easy to deploy” proximally, and that this can be done effectively with three or four coils and a 5Fr catheter. “You can potentially do this in less than 15 minutes,” he added.

Clements then provided a rundown of the trials that he considered significant for their favourable findings on embolization. Firstly, he cited a study of splenic salvage and complications that he was involved in—SPLEEN-IN—which ran from 2009–2019. “We concluded that if you take the entire cohort of grades 3, 4 and 5 […] 97% of patients kept their spleen,” was his summary of the results, published in CardioVascular Interventional Radiology (CVIR) in 2020. Another Australian study that ran from 2005 to 2018 found that splenic artery embolization “reduces the length of hospital stay” in haemodynamically stable blunt splenic injuries.

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