The American journal of gastroenterology · 2026
Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multisite Conjoint Analysis.
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Kao Karissa D, Troost Jonathan P, Yang Ju Dong, Salgia Reena, Woolen Sean A, Mehta Neil, Hoteit Maarouf A, Jalal Prasun K, El Dahan Karim Seif, Daher Darine, Quirk Lisa, Patel Nishi, Nayak Anish, Gamez Jasmine, Alsudaney Manaf, Hernandez Perla, Bhongade Megha, Singal Amit G, Parikh Neehar D
Аннотация
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.
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.