Practice Patterns and Attitudes of Primary Care Providers and Barriers to Surveillance of Hepatocellular Carcinoma in Patients With Cirrhosis
Practice Patterns and Attitudes of Primary Care Providers and Barriers to Surveillance of Hepatocellular Carcinoma in Patients With Cirrhosis
复制标题
DOI：
10.1016/j.cgh.2014.06.031
复制
发表时间：
2015-04-01
影响因子：
12.6
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
--
作者：
Dalton-Fitzgerald, Eimile;Tiro, Jasmin;Singal, Amit G.
背景与目的：只有不到 20% 的肝硬化患者接受肝细胞癌 (HCC) 监测，因此这些肿瘤通常在晚期才被发现。尽管初级保健提供者 (PCP) 为美国 60% 的肝硬化患者提供护理，但人们对他们的 HCC 监测实践模式知之甚少。我们调查了与 PCP 遵守 HCC 监测指南相关的因素。方法：我们对一家大型城市医院的所有 131 名 PCP 进行了一项网络调查。该调查源自经过验证的调查并在提供商之间进行了预先测试；它包括有关提供者和实践特征、自我报告的监测率、监测测试和频率偏好以及对 HCC 监测的态度和障碍的问题。 结果：我们获得了 100% 的诊所级别响应率和 60% 的提供者级别响应率。只有 65% 的受访者报告了每年一次的 HCC 监测，15% 的受访者报告了每两年一次的 HCC 监测。 HCC 监测的障碍包括不了解最新的 HCC 指南（68% 的 PCP）、与患者就 HCC 监测进行有效沟通的困难 (56%) 以及在临床中需要管理的更重要问题 (52%)。大约一半的 PCP (52%) 报告在监测中使用超声波或甲胎蛋白测量； 96% 的人表示这种组合可有效降低 HCC 相关死亡率。然而，许多提供者错误地认为临床检查 (45%) 或肝酶水平 (59%) 或单独的甲胎蛋白 (89%) 是有效的监测工具。结论：PCP 对检测 HCC 的测试存在误解，从而导致监测无效。据报告，监测的障碍包括对指南的了解欠佳，这表明需要采取干预措施，包括提供者教育，以提高 HCC 监测的有效性。
BACKGROUND & AIMS: Fewer than 20% of patients with cirrhosis undergo surveillance for hepatocellular carcinoma (HCC), therefore these tumors often are detected at late stages. Although primary care providers (PCPs) care for 60% of patients with cirrhosis in the United States, 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 a provider-level response rate of 60%. Only 65% of respondents reported annual surveillance 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 the clinic (52%). Approximately half of PCPs (52%) reported using ultrasound or measurements of a-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 a-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.