Author information
1Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX.
2Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
3Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
4Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX; Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
5Department 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. Electronic address: amit.singal@utsouthwestern.edu.
Abstract
BACKGROUND & Aims: Fewer than 20% of patients with cirrhosis undergo surveillance for hepatocellular carcinoma (HCC), so these tumors are often detected at late stages. Although primary care providers (PCPs) follow 60% of patients with cirrhosis in the US, little is known about their practice patterns for HCC surveillance. We investigated factors associated with adherence to guidelines for HCC surveillance by PCPs.
METHODS:
We conducted a web-based survey of all 131 PCPs at a large urban hospital. The survey was derived from validated surveys and pretested among providers; it included questions about provider and practice characteristics, self-reported rates of surveillance, surveillance test and frequency preference, and attitudes and barriers to HCC surveillance.
RESULTS:
We obtained a clinic-level response rate of 100% and provider-level response rate of 60%. Only 65% of respondents reported annual and 15% reported biannual surveillance of patients for HCC. Barriers to HCC surveillance included not being up-to-date with HCC guidelines (68% of PCPs), difficulties in communicating effectively with patients about HCC surveillance (56%), and more important issues to manage in clinic (52%). About half of PCPs (52%) reported using ultrasound or measurements of α-fetoprotein in surveillance; 96% said that this combination was effective in reducing HCC-related mortality. However, many providers incorrectly believed that clinical examination (45%), or levels of liver enzymes (59%) or α-fetoprotein alone (89%), were effective surveillance tools.
CONCLUSIONS:
PCPs have misconceptions about tests to detect HCC that contribute to ineffective surveillance. Reported barriers to surveillance include suboptimal knowledge about guidelines, indicating a need for interventions, including provider education, to increase HCC surveillance effectiveness.