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February 2023 | Issue 89
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
advocate for them to occur as part of the preprocedural work-up”. Eric Keller (Stanford University, Stanford, USA), whose The second recommendation from Keller was to share presentation was delivered in his absence by Isabel Newton alternatives to clinical interventions, to move away from (University of California San Diego, San Diego, USA), what the presenter dubbed “old-school paternalism”. He underlined how “there is more to healing than what we do made the point that “often we do a great job at discussing with our catheters and our wires”. Keller conveyed that our interventions but not at doing the procedure. We are “patients’ perspectives of the quality of our work has also inconsistent in how we handle preprocedure [‘do a lot to do with […] how nice the facility is, our not resuscitate’] DNR orders.” As a remedy, the body language, tone of voice and [whether] presenter suggested that these are dealt with they can get hold of you for questions and “well ahead of time”. concerns”. Therefore, how a patient feels their Finally, Keller emphasised that “healing is a experience with a healthcare practitioner has multifactorial process—it can be easy to forget gone is influenced by how it is framed— the impact of nutrition, spirituality and Keller gave the example of how it is social determinants of health [including] better to tell a patient their biliary the patient’s socioeconomic status, drain will be in for a year and for it living situation, race, etc.” Detailing to come out after six months, than it that physicians tend to be sceptical is to overpromise that it will in of alternative modes of treatment, three months. Keller vouched for talking to patients Keller published a study in 2018 about their use of these so as to be in the Journal of Vascular and more “inclusive”. The concluding Interventional Radiology (JVIR), note was that interventional the presenter went on to share, which radiologists should put a greater illustrated that physicians’ and patients’ Eric Keller emphasis on the precise context in which perceptions of the quality of their care a patient is being cared for—which is shaped depend on different variables. “[Interventional by the aforementioned social factors. Examples radiologists] valued minimising side effects and of how to maximise these contextual aspects of cancer care, complications,” Keller averred, whereas from the patient’s according to Keller, include advanced care planning, shared point of view it is “not so much the actual outcome as decision-making, and engaging patients about other aspects much as not being surprised [by it]”. With this in mind, of their healing to become co-narrators with patients. Keller wished to inform delegates that a physician’s role is as a “co-narrator” who seeks to “understand [the patient’s] Multidisciplinary interventions story” and to help them “write those next few pages”. make a difference Keller then put forward “three important non-procedural The second presenter was Angela Laffan, a nurse interventions that we can do to help maximise our patients’ practitioner based at the University of California San experiences”. The first was advanced care planning, Francisco (San Francisco, USA), who runs a survivorship comprising an assessment of the patient’s goals and programme for patients who have finished treatment with preferences for their care. The recommendation is “to curative intent. “Cancer survivorship is to help optimise facilitate this at the beginning of serious disease”, with patients’ overall wellness,” she outlined for the audience. scope to revise in line with the patient changing their mind, She works primarily with patients with metastatic the presenter relayed. “It does not have to be us [who has these conversations],” Keller continued, “but we can Continued on page 2
Merits of splenectomy versus embolization for trauma patients up for debate 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. Continued on page 4