Barriers to surveillance for hepatocellular cancer among patients with chronic liver disease - providers’ perspectives  

作　　者：Eliza W.Beal Leva Gorji Jaclyn Volney Lindsey Sova Ann Scheck McAlearney Allan Tsung 

机构地区：[1]Departments of Surgery and Oncology,Barbara Ann Karmanos Cancer Institute,Wayne State University School of Medicine,Detroit,MI 48201,USA [2]Department of Surgery,Kettering Health,Dayton,OH 45405,USA [3]The Center for Advancement of Team Science,Analytics,and Systems Thinking in Health Services and Implementation Science Research(CATALYST),College of Medicine,The Ohio State University,Columbus,Ohio 43210,USA [4]Department of Family and Community Medicine,College of Medicine,The Ohio State University,Columbus,Ohio 43210,USA [5]Department of Surgery,Division of Surgical Oncology,University of Virginia,Charlottesville,VA 22904,USA

出　　处：《Hepatoma Research》2023年第1期599-615,共17页肝癌研究(英文版)

基　　金：Dr.Beal’s work was supported by a Pelotonia Postdoctoral Research Fellowship(https://www.pelotonia.org/).

摘　　要：Aims:Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer.While patients who are known to be at high risk for HCC should be under surveillance,only 20%of eligible patients in the United States are surveilled.The aim of this study was to identify providers’perspectives about patient-,provider-and system-level barriers to surveillance for HCC among high-risk patients and to examine provider knowledge and attitudes related to HCC surveillance.We also explored interventions providers suggested as ways to improve HCC surveillance.Methods:Purposive sampling was used to recruit physicians and nurse practitioners in hepatology,gastroenterology,and primary care(internal and family medicine)from one academic medical center to participate in semi-structured interviews.Interviews were transcribed verbatim,and analyzed deductively and inductively to reveal emergent themes.Results:22 informants were interviewed.During these interviews,several important themes emerged,including:(1)Provider comfort with managing chronic liver disease and the relationships between hepatology,gastroenterology,infectious disease,and primary care providers;(2)Provider knowledge of guidelines for HCC surveillance in high-risk patients and their knowledge about the impact that HCC surveillance can have;(3)How providers discuss HCC surveillance with their high-risk patients;(4)Provider-Level barriers to surveillance;(5)System-level barriers to surveillance;(6)COVID-19;(7)Patient-level barriers to surveillance,and(8)Suggested interventions to improve HCC surveillance rates.Conclusions:In designing interventions to improve HCC surveillance rates of high-risk patients in the United States,there are important targets at the patient,provider and system levels.

关 键 词：Hepatocellular carcinoma(HCC) cancer screening CIRRHOSIS chronic liver disease 

分 类 号：R73[医药卫生—肿瘤]