Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas TX.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas TX. Electronic address: firstname.lastname@example.org.
BACKGROUND & AIMS:
Low rates of hepatocellular carcinoma (HCC) surveillance are primarily due to provider-related process failures. However, few studies have evaluated primary care provider (PCP) practice patterns, attitudes, and barriers to HCC surveillance at academic tertiary care referral centers.
We conducted a web-based survey of PCPs at 2 tertiary care referral centers (132 clinics) from June 2017 through December 2017. The survey was adapted from pre-tested surveys and included questions about practice patterns, attitudes, and barriers to HCC surveillance. We used the Fisher exact and Mann-Whitney rank-sum tests to identify factors associated with adherence to HCC surveillance recommendations, for categorical and continuous variables, respectively.
We obtained a provider-level response rate of 75% and clinic-level response rate of 100% (132 clinics). Whereas most PCPs performed HCC surveillance themselves, one-third deferred surveillance to subspecialists and referred patients to hepatology clinic. Providers believed the combination of ultrasound and alpha fetoprotein analysis to be highly effective for early-stage tumor detection and reported using the combination for assessment of most patients. However, PCPs were more likely to use computed tomography- or magnetic resonance imaging-based surveillance for patients with nonalcoholic steatohepatitis or decompensated cirrhosis. Most providers believed HCC surveillance to be efficacious for early tumor detection and increasing survival. However, they desired increased high-quality evidence to characterize screening benefits and harms. Providers expressed notable misconceptions about HCC surveillance, including the role for measurement of liver enzymes in HCC surveillance and cost effectiveness of surveillance in patients without cirrhosis. They also reported barriers, including no being up to date on HCC surveillance recommendations, limited time in clinic, and competing clinical concerns.
In a web-based survey, PCPs reported misconceptions and barriers to HCC surveillance. These indicate the need for interventions, including provider education, to improve HCC surveillance effectiveness in clinical practice.