Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multisite Conjoint Analysis.
| Title: | Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multisite Conjoint Analysis. |
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| Authors: | Kao KD; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.; Troost JP; Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA.; Yang JD; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.; Salgia R; Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA.; Woolen SA; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.; Mehta N; Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA.; Hoteit MA; Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; Jalal PK; Section of Gastroenterology & Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.; El Dahan KS; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA .; Daher D; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA .; Quirk L; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA .; Patel N; Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; Nayak A; Section of Gastroenterology & Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.; Gamez J; Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA.; Alsudaney M; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.; Hernandez P; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.; Bhongade M; Section of Gastroenterology & Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.; Singal AG; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA .; Parikh ND; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA. |
| Source: | The American journal of gastroenterology [Am J Gastroenterol] 2026 Apr 10. Date of Electronic Publication: 2026 Apr 10. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 0421030 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1572-0241 (Electronic) Linking ISSN: 00029270 NLM ISO Abbreviation: Am J Gastroenterol Subsets: MEDLINE |
| Imprint Name(s): | Publication: : [Philadelphia, PA] : Wolters Kluwer Health; Original Publication: New York, Elsevier Science, -2003. |
| Abstract: | Introduction: Several emerging modalities are available for hepatocellular carcinoma (HCC) surveillance; however, patient preferences for surveillance tests-particularly across key subgroups such as race/ethnicity, income, and education level-are poorly characterized.; Methods: We conducted a choice-based conjoint survey among patients with cirrhosis and chronic hepatitis B undergoing HCC surveillance (from 2022 to 2024) at 7 centers in the United States. Participants were presented with 15 scenarios, where they chose between surveillance modalities based on test attributes.; Results: We included 649 patients, with a median age of 60 years, 51% male, 60% White, 10% Black, and 20% Hispanic. The cohort reflected substantial socioeconomic variation including 12% with Medicaid and 38% with Medicare. The highest priority attribute was surveillance benefits (42.9%; 95% confidence interval [CI] 40.6%-45.1%), followed by financial harms (19.4%; 95% CI 18.1%-20.7%). Patients placed less priority on test logistics (12.3%; 95% CI 11.5%-13.2%), test location (9.2%; 95% CI 8.5%-10.0%), test duration (8.3%; 95% CI 7.8%-8.7%), and physical harms (7.9%; 95% CI 7.2%-8.6%). In subgroup analyses, Black participants placed significantly lower importance on surveillance benefits and higher importance on financial harms ( P < 0.001) and test duration ( P = 0.001) compared with White participants. Hispanic participants also prioritized financial harms more than non-Hispanic participants ( P < 0.001), a pattern consistent with cost-related concerns seen across other lower socioeconomic status (SES) subgroups. Lower SES individuals with below a high school education ( P = 0.01), Medicaid insurance ( P = 0.001), and income below $25,000 ( P < 0.001) assigned greater importance to financial harms and less to surveillance benefits.; Discussion: Patients with undergoing HCC surveillance prioritize surveillance test sensitivity; however, results vary by race, ethnicity, and SES. Improving access by reducing financial and logistical barriers through shared decision-making may enhance surveillance, particularly when modalities present with similar effectiveness.; (Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.) |
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| Grant Information: | RP200554 CIPRT; U01CA271887 Division of Cancer Prevention, National Cancer Institute; U01CA283935 Division of Cancer Prevention, National Cancer Institute |
| Contributed Indexing: | Keywords: HCC; SES; cirrhosis; screening |
| Entry Date(s): | Date Created: 20260414 Latest Revision: 20260522 |
| Update Code: | 20260522 |
| DOI: | 10.14309/ajg.0000000000004023 |
| PMID: | 41979434 |
| Database: | MEDLINE |
Journal Article