Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma

J Clin Gastroenterol. 2011 Sep;45(8):727-32. doi: 10.1097/MCG.0b013e31820989d3.

Abstract

Background: Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but earlier studies suggest that it is used less than one-third of the time. Patient factors associated with surveillance rates are incompletely understood.

Goals: The aims of our study were to determine HCC surveillance rates in a tertiary-care center and to identify patient predictors of receiving surveillance.

Study: Patients with Child A or B cirrhosis seen in the University of Michigan liver clinics between October 2008 and March 2009 were enrolled to complete a self-administered survey. Surveillance rates and clinical data were extracted from the patient electronic medical record.

Results: Of the 160 patients enrolled, 74.4% had HCC surveillance performed in the past year. On multivariate analysis, predictors of receiving surveillance included male sex (odds ratio 7.1, 95% confidence interval, 1.2-43.2) and patient involvement in their care (odds ratio 3.4, 95% confidence interval, 1.5-7.9). Patients expressed high levels of concern regarding HCC, desired more information from their physicians, and wanted to be more involved in their care.

Conclusions: HCC surveillance rates in a tertiary-care center were significantly higher than earlier reported rates. Direct patient involvement in decisions regarding HCC surveillance may help to improve surveillance rates.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnosis*
  • Carcinoma, Hepatocellular / etiology
  • Disease Progression
  • Female
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis*
  • Liver Neoplasms / diagnosis*
  • Liver Neoplasms / etiology
  • Logistic Models
  • Male
  • Michigan
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Compliance
  • Patient Education as Topic
  • Patient Participation*
  • Perception
  • Predictive Value of Tests
  • Prognosis
  • Severity of Illness Index
  • Sex Factors
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult