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Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States
Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States
- Source :
- Clin Gastroenterol Hepatol
- Publication Year :
- 2020
-
Abstract
- BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers’ opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient’s HCC risk on the choice of surveillance modality. METHODS: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 U.S. medical centers in 17 states. RESULTS: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient’s HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; p
- Subjects :
- Liver Cirrhosis
medicine.medical_specialty
Cirrhosis
Carcinoma, Hepatocellular
Attitude of Health Personnel
Computed tomography
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
In patient
neoplasms
Early Detection of Cancer
Ultrasonography
Hepatology
medicine.diagnostic_test
business.industry
Diagnostic Tests, Routine
Liver Neoplasms
Gastroenterology
Treatment options
medicine.disease
digestive system diseases
United States
Clinical Practice
030220 oncology & carcinogenesis
Hepatocellular carcinoma
Emergency medicine
030211 gastroenterology & hepatology
alpha-Fetoproteins
Liver cancer
business
Subjects
Details
- ISSN :
- 15427714
- Volume :
- 20
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
- Accession number :
- edsair.doi.dedup.....d58a664712624605f3136483caf89f6a