Patient Preferences for Hepatocellular Carcinoma Surveillance Parameters.
HCC
Harms
Screening
Sensitivity
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
22
12
2020
revised:
01
02
2021
accepted:
15
02
2021
pubmed:
23
2
2021
medline:
16
3
2022
entrez:
22
2
2021
Statut:
ppublish
Résumé
Professional societies recommend abdominal ultrasound (US) with or without alpha fetoprotein (AFP) for hepatocellular cancer (HCC) surveillance; however, there are several emerging surveillance modalities, including abbreviated MRI and blood-based biomarker panels. Most studies have focused on provider perspectives for surveillance logistics, but few have assessed patient preferences. We aimed to measure preferences among patients with cirrhosis regarding HCC surveillance modalities. We conducted a choice-based conjoint survey to patients with cirrhosis at four institutions. Participants were provided 15 scenarios in which they were asked to choose surveillance modalities based on five test attributes: benefits, i.e. sensitivity for early HCC (range: 35-95%), physical harm, i.e. false positives requiring additional testing (range: 10-40%), financial harm, i.e. out-of-pocket costs (range: $10-100), test logistics and convenience, i.e. duration of testing (range: 10-60 min). Hierarchical Bayes discrete choice conjoint analysis was used to derive attribute importance, and preference shares were determined by simulation. In total 91% (182/199) of approached patients consented to participate in the study and 98% (n=179) successfully completed the survey. Surveillance benefits (importance: 51.3%, 95%CI: 49.0-53.4%) were valued more than risk of physical harm (importance: 7.6%, 95%CI 7.0-8.2%), financial harm (importance: 15.2%, 95%CI 14.0-16.3%), convenience (importance: 9.3%, 95%CI 8.5-10.1%) and test logistics (importance: 16.7%, 95%CI 15.4-18.1%). Based on simulations including all possible tests, patients preferred abbreviated MRI (29.0%), MRI (23.3%), or novel blood-based biomarkers (20.9%) to ultrasound alone (3.4%) or with AFP (8.8%). Patients with cirrhosis prioritize early HCC detection over potential surveillance-related harms or inconvenience.
Sections du résumé
BACKGROUND AND AIMS
Professional societies recommend abdominal ultrasound (US) with or without alpha fetoprotein (AFP) for hepatocellular cancer (HCC) surveillance; however, there are several emerging surveillance modalities, including abbreviated MRI and blood-based biomarker panels. Most studies have focused on provider perspectives for surveillance logistics, but few have assessed patient preferences. We aimed to measure preferences among patients with cirrhosis regarding HCC surveillance modalities.
METHODS
We conducted a choice-based conjoint survey to patients with cirrhosis at four institutions. Participants were provided 15 scenarios in which they were asked to choose surveillance modalities based on five test attributes: benefits, i.e. sensitivity for early HCC (range: 35-95%), physical harm, i.e. false positives requiring additional testing (range: 10-40%), financial harm, i.e. out-of-pocket costs (range: $10-100), test logistics and convenience, i.e. duration of testing (range: 10-60 min). Hierarchical Bayes discrete choice conjoint analysis was used to derive attribute importance, and preference shares were determined by simulation.
RESULTS
In total 91% (182/199) of approached patients consented to participate in the study and 98% (n=179) successfully completed the survey. Surveillance benefits (importance: 51.3%, 95%CI: 49.0-53.4%) were valued more than risk of physical harm (importance: 7.6%, 95%CI 7.0-8.2%), financial harm (importance: 15.2%, 95%CI 14.0-16.3%), convenience (importance: 9.3%, 95%CI 8.5-10.1%) and test logistics (importance: 16.7%, 95%CI 15.4-18.1%). Based on simulations including all possible tests, patients preferred abbreviated MRI (29.0%), MRI (23.3%), or novel blood-based biomarkers (20.9%) to ultrasound alone (3.4%) or with AFP (8.8%).
CONCLUSIONS
Patients with cirrhosis prioritize early HCC detection over potential surveillance-related harms or inconvenience.
Identifiants
pubmed: 33618022
pii: S1542-3565(21)00202-0
doi: 10.1016/j.cgh.2021.02.024
pmc: PMC9150784
mid: NIHMS1675890
pii:
doi:
Substances chimiques
alpha-Fetoproteins
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
204-215.e6Subventions
Organisme : NCI NIH HHS
ID : U01 CA230694
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD012565
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA230669
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK062708
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA212008
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Clin Gastroenterol Hepatol. 2021 Sep;19(9):1925-1932.e1
pubmed: 32920214
PLoS Med. 2014 Apr 01;11(4):e1001624
pubmed: 24691105
Cancer. 2016 May 1;122(9):1312-37
pubmed: 26959385
Aliment Pharmacol Ther. 2013 Aug;38(3):303-12
pubmed: 23750991
JAMA Oncol. 2017 Apr 01;3(4):456-463
pubmed: 27657493
Hepatology. 2018 Jan;67(1):358-380
pubmed: 28130846
Hepatology. 2021 Feb;73(2):713-725
pubmed: 32383272
Cancer Epidemiol Biomarkers Prev. 2020 Dec;29(12):2495-2503
pubmed: 32238405
BMJ. 2013 Sep 16;347:f5334
pubmed: 24041703
Gastroenterology. 2019 Jul;157(1):54-64
pubmed: 30986389
Value Health. 2016 Jun;19(4):300-15
pubmed: 27325321
J Cancer Res Clin Oncol. 2004 Jul;130(7):417-22
pubmed: 15042359
Cancer. 2016 Aug 15;122(16):2512-23
pubmed: 27195481
Clin Gastroenterol Hepatol. 2022 Jan;20(1):9-18
pubmed: 32961340
Am J Med. 2017 Sep;130(9):1099-1106.e1
pubmed: 28213044
Liver Int. 2020 Apr;40(4):947-955
pubmed: 31943689
Hepatology. 2018 Aug;68(2):723-750
pubmed: 29624699
Clin Gastroenterol Hepatol. 2016 Jun;14(6):875-886.e6
pubmed: 26775025
Am J Gastroenterol. 2014 Apr;109(4):542-53
pubmed: 24513805
Liver Transpl. 2019 Mar;25(3):369-379
pubmed: 30582779
Clin Gastroenterol Hepatol. 2020 Mar;18(3):728-735.e4
pubmed: 31712073
Clin Radiol. 2018 May;73(5):485-493
pubmed: 29246586
Abdom Radiol (NY). 2017 Jan;42(1):179-190
pubmed: 27448609
Gastroenterology. 2018 May;154(6):1706-1718.e1
pubmed: 29425931
J Hepatol. 2018 Jul;69(1):182-236
pubmed: 29628281
Eur Radiol. 2020 Nov;30(11):6003-6013
pubmed: 32588209
Clin Gastroenterol Hepatol. 2019 Feb;17(3):551-559.e1
pubmed: 29859983
Arch Surg. 2010 Dec;145(12):1158-63
pubmed: 21173289
Biomark Res. 2017 Apr 21;5:15
pubmed: 28439416
J Clin Gastroenterol. 2011 Sep;45(8):727-32
pubmed: 21602704
Hepatology. 2017 Apr;65(4):1196-1205
pubmed: 27775821