Author information

¹Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.

²UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA. Andrew.Moon@unchealth.unc.edu.

³Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.

⁴Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA.

⁵Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

⁶Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

⁷UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA.

⁸Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.

⁹Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.

¹⁰Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.

¹¹Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

¹²Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

¹³Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA.

¹⁴Division of General Internal Medicine, University of Washington, VA Puget Sound Healthcare System, Seattle, USA.

Abstract

Background: Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with improved survival. Provision of HCC surveillance is low in the US, particularly in primary care settings.

Aims: To evaluate current hepatitis C virus (HCV) and HCC surveillance practices and physician attitudes regarding HCC risk-stratification among primary care and subspecialty providers.

Methods: Using the Tailored Design Method, we delivered a 34-item online survey to 7654 North Carolina-licensed internal/family medicine or gastroenterology/hepatology physicians and advanced practice providers in 2022. We included the domains of HCV treatment, cirrhosis diagnosis, HCC surveillance practices, barriers to surveillance, and interest in risk-stratification tools. We performed descriptive analyses to summarize responses. Tabulations were weighted based on sampling weights accounting for non-response and inter-specialty comparisons were made using chi-squared or t test statistics.

Results: After exclusions, 266 responses were included in the final sample (response rate 3.8%). Most respondents (78%) diagnosed cirrhosis using imaging and a minority used non-invasive tests that were blood-based (~ 15%) or transient elastography (31%). Compared to primary care providers, subspecialists were more likely to perform HCC surveillance every 6-months (vs annual) (98% vs 35%, p < 0.0001). Most respondents (80%) believed there were strong data to support HCC surveillance, but primary care providers did not know which liver disease patients needed surveillance. Most providers (> 70%) expressed interest in potential solutions to improve HCC risk-stratification.

Conclusions: In this statewide survey, there were great knowledge gaps in HCC surveillance among PCPs and most respondents expressed interest in strategies to increase appropriate HCC surveillance.