Factors Influencing the Uptake of Magnetic Resonance Imaging-Guided High Intensity Focused Ultrasound for Painful Bone Metastases in Europe: A Group Concept Mapping Study

OBJECTIVES: The FURTHER-trial is a randomized controlled trial assessing the effectiveness of magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) for pain palliation in patients with bone metastases. Although evidence from the FURTHER-trial will be paramount to the uptake of MR-HIFU, implementation of medical technologies is often influenced by multiple interacting factors related to the intervention and contextual factors. To investigate the factors influencing the uptake of MR-HIFU, we applied a Group Concept Mapping (GCM) alongside the FURTHER-trial in four European countries.

METHODS: Participants were selected through purposive and snowball sampling. The GCM was conducted in two phases. First, participants were asked to brainstorm statements guided by a focus prompt “One factor that may influence the uptake of MR-HIFU in clinical practice in my country is...”. Second, participants were asked to sort statements into different categories depending on how they were related to each other; and to rate the statements according to their importance and changeability. Data generated in the second phase were analyzed through multivariate analyses (i.e., multidimensional scaling and cluster analysis) to generate a concept map, and the computation of average ratings for each factor and cluster of factors.

RESULTS: From 79 invited participants, 45 contributed to the brainstorming (n=28) and/or the sorting and rating phase (n=33), resulting in an overall 56% participation rate. During the first phase, 71 statements were collected. After adjusting for redundancy and potential ambiguity, 49 statements remained to be sorted and rated in the second phase. The resulting concept map comprised seven clusters of factors: procedure-related, patient eligibility, clinician’s acceptance, evidentiary aspects/effectiveness, logistics, reimbursement and cost-effectiveness.

CONCLUSIONS: The results echoed those described in previous implementation empiric studies for other medical devices. GCM offered a structured process that allowed engagement of different stakeholders alongside the clinical trial, thus constructing a basis for advising the implementation of MR-HIFU in Europe.