Physician-and patient-reported barriers to hepatocellular carcinoma surveillance: a nationwide survey

Background Hepatocellular carcinoma (HCC) surveillance rates are suboptimal. We aimed to identify HCC surveillance barriers from both physician and patient perspectives and assess the effectiveness of physician education using social networks. Methods A nationwide survey with 513 physicians and another single-center survey with 315 HCC-risk patients were conducted. Regression analysis was used to identify surveillance barriers. We educated 143 physicians by sending brief notes on HCC surveillance guidelines via social networks and re-evaluated their knowledge at 60 days using paired T-test.Results Surveys showed 458 (86.3%), 254 (47.8%) and 225 (42.4%) physicians recommended surveillance in patients with cirrhosis, at-risk HBV and HCV infection, respectively. Only 228 (42.9%) and 241 (38.0%) respondents adhered to recommended surveillance tools and interval, respectively. The main surveillance barriers among physicians were the lack of knowledge and resource limitations. The lack of a doctor’s prescription was identified as main barrier by patients (relative risk 1.4, 95%CI 1.1-1.8, p=0.024). Social networks education enhanced physicians’ knowledge pre-and post-education scores for guideline awareness: (63.0%vs.84.3%, pConclusions Physicians’ knowledge gap was primary barrier for adherence to HCC surveillance protocols. Brief education via social networks showed effectiveness at increasing knowledge of HCC surveillance with medical residents.Clinical trial registry: This study was registered to the Thai clinical trial registry (TCTR number 20210127006). Registered 22 July 2021- Retrospectively registered. http://www.clinicaltrials.in.th/