Eliza W Beal1,2, Mackenzie Owen3, Molly McNamara3, Ann Scheck McAlearney4,5,6, Allan Tsung4,5. 1. The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA. ewbeal@gmail.com. 2. The Center for the Advancement of Team Science, Systems Thinking in Health Services and Implementation Science Research (CATALYST, The Ohio State University College of Medicine, AnalyticsColumbus, OH, 43210, USA. ewbeal@gmail.com. 3. The Ohio State University College of Medicine, Columbus, OH, 43210, USA. 4. The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA. 5. The Center for the Advancement of Team Science, Systems Thinking in Health Services and Implementation Science Research (CATALYST, The Ohio State University College of Medicine, AnalyticsColumbus, OH, 43210, USA. 6. The Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH, 43210, USA.
Abstract
PURPOSE: Hepatocellular carcinoma has a dismal prognosis, except in patients diagnosed early who are candidates for potentially curative therapies. Most HCC cases develop in patients with chronic liver disease. Therefore, expert society guidelines recommend surveillance every 6 months with ultrasound with or without serum alpha-fetoprotein for high-risk patients. However, fewer than 20% of patients in the USA undergo appropriate surveillance. METHODS: A systematic scoping review was performed with the objective of identifying barriers to screening among high-risk patients in the USA including mapping key concepts in the relevant literature, identifying the main sources and types of evidence available, and identifying gaps in the literature. A total of 43 studies published from 2007 to 2021 were included. Data were extracted and a conceptual framework was created. RESULTS: Assessment of quantitative studies revealed poor surveillance rates, often below 50%. Three categories of barriers to surveillance were identified: patient-level, provider-level, and system-level barriers. Prevalent patient-level barriers included financial constraints, lack of awareness of surveillance recommendations, and scheduling difficulties. Common provider-level barriers were lack of provider awareness of guidelines for surveillance, difficulty accessing specialty resources, and time constraints in the clinic. System-level barriers included fewer clinic visits and rural/safety-net settings. Proposed interventions include improved patient/provider education, patient navigators, increased community/academic collaboration, and EMR-based reminders. CONCLUSION: Based on these findings, there is a crucial need to implement and evaluate proposed interventions to improve HCC surveillance.
PURPOSE: Hepatocellular carcinoma has a dismal prognosis, except in patients diagnosed early who are candidates for potentially curative therapies. Most HCC cases develop in patients with chronic liver disease. Therefore, expert society guidelines recommend surveillance every 6 months with ultrasound with or without serum alpha-fetoprotein for high-risk patients. However, fewer than 20% of patients in the USA undergo appropriate surveillance. METHODS: A systematic scoping review was performed with the objective of identifying barriers to screening among high-risk patients in the USA including mapping key concepts in the relevant literature, identifying the main sources and types of evidence available, and identifying gaps in the literature. A total of 43 studies published from 2007 to 2021 were included. Data were extracted and a conceptual framework was created. RESULTS: Assessment of quantitative studies revealed poor surveillance rates, often below 50%. Three categories of barriers to surveillance were identified: patient-level, provider-level, and system-level barriers. Prevalent patient-level barriers included financial constraints, lack of awareness of surveillance recommendations, and scheduling difficulties. Common provider-level barriers were lack of provider awareness of guidelines for surveillance, difficulty accessing specialty resources, and time constraints in the clinic. System-level barriers included fewer clinic visits and rural/safety-net settings. Proposed interventions include improved patient/provider education, patient navigators, increased community/academic collaboration, and EMR-based reminders. CONCLUSION: Based on these findings, there is a crucial need to implement and evaluate proposed interventions to improve HCC surveillance.
Authors: Julie K Heimbach; Laura M Kulik; Richard S Finn; Claude B Sirlin; Michael M Abecassis; Lewis R Roberts; Andrew X Zhu; M Hassan Murad; Jorge A Marrero Journal: Hepatology Date: 2018-01 Impact factor: 17.425
Authors: Patrick S Harris; Ross M Hansen; Meagan E Gray; Omar I Massoud; Brendan M McGuire; Mohamed G Shoreibah Journal: World J Gastroenterol Date: 2019-04-07 Impact factor: 5.742