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Patient Involvement in Healthcare is Associated With Higher Rates of Surveillance for Hepatocellular Carcinoma

Singal, Amit G. MD, MS*; Volk, Michael L. MD, MS*; Rakoski, Mina O. MD, MS*; Fu, Sherry MD*; Su, Grace L. MD*,†; McCurdy, Heather RN; Marrero, Jorge A. MD, MS*

Journal of Clinical Gastroenterology: September 2011 - Volume 45 - Issue 8 - p 727–732
doi: 10.1097/MCG.0b013e31820989d3

Background Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but earlier studies suggest that it is used less than one-third of the time. Patient factors associated with surveillance rates are incompletely understood.

Goals The aims of our study were to determine HCC surveillance rates in a tertiary-care center and to identify patient predictors of receiving surveillance.

Study Patients with Child A or B cirrhosis seen in the University of Michigan liver clinics between October 2008 and March 2009 were enrolled to complete a self-administered survey. Surveillance rates and clinical data were extracted from the patient electronic medical record.

Results Of the 160 patients enrolled, 74.4% had HCC surveillance performed in the past year. On multivariate analysis, predictors of receiving surveillance included male sex (odds ratio 7.1, 95% confidence interval, 1.2-43.2) and patient involvement in their care (odds ratio 3.4, 95% confidence interval, 1.5-7.9). Patients expressed high levels of concern regarding HCC, desired more information from their physicians, and wanted to be more involved in their care.

Conclusions HCC surveillance rates in a tertiary-care center were significantly higher than earlier reported rates. Direct patient involvement in decisions regarding HCC surveillance may help to improve surveillance rates.

Supplemental Digital Content is available in the article.

*Department of Internal Medicine, University of Michigan

Ann Arbor Veterans Administration Health System, Ann Arbor, MI

Financial disclosures: Nothing to declare.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Reprints: Amit G. Singal, MD, MS, Division of Gastroenterology, University of Texas Southwestern, 5959 Harry Hines Boulevard, POB 1, Suite 420, Dallas, TX 75390-8887 (e-mail:

Received July 30, 2010

Accepted December 1, 2010

© 2011 Lippincott Williams & Wilkins, Inc.