Back to Search Start Over

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

Authors :
David A. Jacob
Andres Duarte-Rojo
Cynthia Levy
Mandana Khalili
Abbey Barnard
Shaun Chandna
Parul D. Agarwal
Hersh Shroff
Neil Mehta
Amit G. Singal
Anjana Pillai
Nicole J. Kim
Ponni V. Perumalswami
Hyun-Seok Kim
Michael Fuchs
Christina C. Lindenmeyer
Francis Y. Yao
Kali Zhou
Veronica Nguyen
Patricia P. Bloom
Nicole E. Rich
Karine Rozenberg-Ben-Dror
Catherine Frenette
Yuval A. Patel
Elizabeth S. Aby
Jihane N. Benhammou
George N. Ioannou
Ju Dong Yang
Andrew M. Moon
Jin Ge
Michael D. Leise
Nyan L. Latt
Robert J. Wong
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

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