Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis.
Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis.
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DOI：
10.1016/j.cgh.2020.06.049
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Hernaez R
中科院分区：
文献类型：
--
作者：
Singal AG;Tiro JA;Murphy CC;Blackwell JM;Kramer JR;Khan A;Liu Y;Zhang S;Phillips JL;Hernaez R
超过20%的肝硬化患者没有按照建议接受半年一次的肝细胞癌（HCC）监测。很少有研究评估了患者水平的因素对监测接收的影响。我们对来自3个卫生系统（三级医疗转诊中心、安全网卫生系统和退伍军人事务部）的肝硬化患者进行了一项电话调查，以描述患者对HCC监测的知识、态度和感知障碍。进行多项逻辑回归，以确定与调查管理前12个月期间HCC监测接收（半年和每年vs无）相关的因素。在2871例患者中，1020例（35.5%）完成了调查。患者对肝癌的发展高度关注，对肝癌的知识水平较高。然而，患者存在知识缺陷，包括认为在体格检查和实验室结果正常时不需要监测。近一半的患者报告了监测的障碍，包括费用（28.9%），时间安排困难（24.1%）和交通（17.8%）。在调查前一年，745例患者（73.1%）接受了1次或以上的监测检查; 281例接受了定期、半年一次的监测，464例接受了年度监测。半年一次的HCC监测（与无）与接受肝病专科治疗显著相关（比值比，30.1; 95%CI，17.5 - 51.8），与患者报告的障碍呈负相关（比值比，0.62; 95%CI，0.41 - 0.94）。每年与无监测相比，关联模式相似，但影响程度降低。患者报告的障碍，如知识不足，成本，调度困难和运输与HCC监测的频率较低显着相关，表明需要以患者为中心的干预措施，如患者导航。
More than 20% of patients with cirrhosis do not receive semi-annual hepatocellular carcinoma (HCC) surveillance as recommended. Few studies have evaluated the effects of patient-level factors on surveillance receipt. We administered a telephone survey to a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) to characterize patient knowledge, attitudes, and perceived barriers of HCC surveillance. Multinomial logistic regression was performed to identify factors associated with HCC surveillance receipt (semi-annual and annual vs none) during the 12-month period preceding survey administration. Of 2871 patients approached, 1020 (35.5%) completed the survey. Patients had high levels of concern about developing HCC and high levels of knowledge about HCC. However, patients had knowledge deficits, including believing surveillance was unnecessary when physical examination and laboratory results were normal. Nearly half of patients reported barriers to surveillance, including costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%). In the year before the survey, 745 patients (73.1%) received 1 or more surveillance examination; 281 received on-schedule, semi-annual surveillance and 464 received annual surveillance. Semi-annual HCC surveillance (vs none) was significantly associated with receipt of hepatology subspecialty care (odds ratio, 30.1; 95% CI, 17.5 – 51.8) and inversely associated with patient-reported barriers (odds ratio, 0.62; 95% CI, 0.41 – 0.94). Patterns of associations comparing annual vs no surveillance were similar although the magnitude of effects were reduced. Patient-reported barriers such as knowledge deficits, costs, difficulty scheduling, and transportation are significantly associated with less-frequent receipt of HCC surveillance, indicating a need for patient-centered interventions, such as patient navigation.
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