title: Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis.
abstract: Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.25-7.62) and significantly lower in those reporting barriers to surveillance (OR, 0.42; 95% CI, 0.25-0.70).
  
  
  
  Patients with cirrhosis are knowledgeable and interested in HCC surveillance; however, patient-reported barriers are associated with lower surveillance rates in clinical practice and represent potential intervention targets to improve HCC surveillance effectiveness. (Hepatology 2017;65:875-884).
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Sherean
authors.initials: S
authors.lastname: Farvardin
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Jaimin
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Maleka
authors.initials: M
authors.lastname: Khambaty
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Olutola A
authors.initials: OA
authors.lastname: Yerokun
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Huram
authors.initials: H
authors.lastname: Mok
authors.affiliation: Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Tiro
authors.affiliation: Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX.|Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.|Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
mesh_terms: D000328:Adult; D001294:Attitude to Health; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000592:standards* / Q000639:trends; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011159:Population Surveillance; D044469:Racial Groups; D018570:Risk Assessment; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States