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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Adherence to guideline-directed hepatocellular carcinoma screening: A single-center US experience
William W King, Raymond Richhart, Tyler Culpepper, Maneola Mota, Debdeep Banerjee, Media Ismael, Joydeep Chakraborty, Michael Ladna, Walid Khan, Nicole Ruiz, Jake Wilson, Ellery Altshuler, Virginia Clark, Roniel Cabrera
William W King, Raymond Richhart, Tyler Culpepper, Debdeep Banerjee, Nicole Ruiz, Jake Wilson, Ellery Altshuler, Department of Medicine, University of Florida, Gainesville, FL 32610, United States
Maneola Mota, Media Ismael, Joydeep Chakraborty, Virginia Clark, Roniel Cabrera, Department of Gastroenterology, University of Florida, Gainesville, FL 32610, United States
Michael Ladna, Walid Khan, Department of Hospital Medicine, University of Florida, Gainesville, FL 32610, United States
Author contributions: King WW conducted a plurality of this work; Mota M, Clark V, and Cabrera R developed the study concept and design; King W, Richhart R, Culpepper T, Mota M, Banerjee D, Ismael M, Chakraborty J, Ladna M, Khan W, Ruiz N, and Wilson J performed data acquisition; King W and Culpepper T performed statistical analysis; King W wrote the manuscript; Richhart R, Culpepper T, Altshuler E, Clark V, and Cabrera R assisted with revision and editing; Clark V and Cabrera R supervised this work.
Institutional review board statement: This research was approved by the Institutional Review Board of the University of Florida.
Informed consent statement: Informed consent was therefore not obtained from each individual patient. This process was approved by the institutional review board at the authors’ home institution, the University of Florida. Please contact the corresponding author with any questions or concerns.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: De-identified patient data, study protocols, and statistical analysis protocols are available to be shared.
STROBE statement: STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: William W King, MD, Doctor, Department of Medicine, University of Florida, 1600 SW Archer Rd Room 4102, Gainesville, FL 32610, United States.
william.king@medicine.ufl.edu
Received: November 11, 2022
Peer-review started: November 12, 2022
First decision: January 5, 2023
Revised: January 16, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 27, 2023
Processing time: 131 Days and 3.9 Hours
ARTICLE HIGHLIGHTS
Research background
The American Association for the Study of Liver Disease recommends that patients with cirrhosis be screened for hepatocellular carcinoma (HCC) every six months. Other researchers have shown that adherence to these guidelines is poor, but little is known about the causes of this failure.
Research motivation
The authors noted that many patients in their own subspecialty hepatology practice did not undergo appropriate screening. They studied factors contributing to screening failure in order to develop a possible quality improvement initiative.
Research objectives
The authors sought to identify root causes of HCC screening failure among patients with cirrhosis in their subspecialty heaptology clinic.
Research methods
The authors identified patients with cirrhosis in their subspecialty hepatology clinic and determined whether they underwent appropriate screening. The authors reviewed the medical records of patients who did not undergo appropriate screening to identify the root causes of screening failure.
Research results
Among 1034 patients, only 489 underwent appropriate screening. The most common causes of screening failure, in descending order, were: radiology unable to schedule timely imaging, provider did not order imaging, patient canceled follow up appointment, appointments scheduled too far apart, lost to follow up, no-show to radiology appointment, and provider canceled appointment.
Research conclusions
Even in a subspecialty hepatology clinic in which providers strive to follow guideline-based HCC screening, rates of screening were still poor. Most of the barriers to appropriate screening were due to systemic factors such as radiology availability, rather than to individual error.
Research perspectives
HCC screening is vital to the comprehensive care of patients with cirrhosis, yet systemic and institutional barriers often prevent patients from receiving adequate care. The root causes identified in this article immediately suggest areas for possible quality improvement and provide guidance to those at other institutions.
