Background

More than 20% of patients with cirrhosis do not receive semi-annual hepatocellular carcinoma (HCC) surveillance as recommended. Few studies have evaluated the effects of patient-level factors on surveillance receipt.

Methods

We administered a telephone survey to a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) to characterize patient knowledge, attitudes, and perceived barriers of HCC surveillance. Multinomial logistic regression was performed to identify factors associated with HCC surveillance receipt (semi-annual and annual vs none) during the 12-month period preceding survey administration.

Results

Of 2871 patients approached, 1020 (35.5%) completed the survey. Patients had high levels of concern about developing HCC and high levels of knowledge about HCC. However, patients had knowledge deficits, including believing surveillance was unnecessary when physical examination and laboratory results were normal. Nearly half of patients reported barriers to surveillance, including costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%). In the year before the survey, 745 patients (73.1%) received 1 or more surveillance examination; 281 received on-schedule, semi-annual surveillance and 464 received annual surveillance. Semi-annual HCC surveillance (vs none) was significantly associated with receipt of hepatology subspecialty care (odds ratio, 30.1; 95% CI, 17.5–51.8) and inversely associated with patient-reported barriers (odds ratio, 0.62; 95% CI, 0.41–0.94). Patterns of associations comparing annual vs no surveillance were similar although the magnitude of effects were reduced.

Conclusions

Patient-reported barriers such as knowledge deficits, costs, difficulty scheduling, and transportation are significantly associated with less frequent receipt of HCC surveillance, indicating a need for patient-centered interventions, such as patient navigation.

中文翻译：

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患者报告的障碍与多中心肝硬化患者队列中接受肝细胞癌监测相关

背景

超过 20% 的肝硬化患者没有按照建议接受每半年一次的肝细胞癌 (HCC) 监测。很少有研究评估患者层面因素对监测接收的影响。

方法

我们对来自 3 个卫生系统（三级护理转诊中心、安全网卫生系统和退伍军人事务部）的大量肝硬化患者进行了电话调查，以了解患者对 HCC 监测的知识、态度和感知障碍。进行多项 Logistic 回归以确定在调查实施前 12 个月期间与 HCC 监测接收相关的因素（半年和每年与无）。

结果

在 2871 名患者中，1020 名 (35.5%) 完成了调查。患者对发生肝癌的担忧程度较高，对肝癌的了解程度较高。然而，患者存在知识缺陷，包括认为当体检和实验室结果正常时就没有必要进行监测。近一半的患者报告了监测障碍，包括费用（28.9%）、安排困难（24.1%）和交通（17.8%）。调查前一年，745名患者（73.1%）接受过1次或以上监测检查；281 人接​​受了按时半年一次的监测，464 人接受了年度监测。每半年 HCC 监测（相对于没有监测）与接受肝病亚专科护理显着相关（比值比，30.1；95% CI，17.5-51.8），与患者报告的障碍呈负相关（比值比，0.62；95% CI， 0.41–0.94）。尽管影响程度有所降低，但比较年度监测与无监测的关联模式相似。

结论

患者报告的障碍（例如知识缺陷、成本、安排困难和交通）与 HCC 监测频率较低显着相关，这表明需要以患者为中心的干预措施，例如患者导航。