Rural Medical Practitioner and Public Health Registrar, NT
Optimal liver cancer surveillance in the community: do recall and reminder systems hold the answer?
In this presentation, Dr Nicole Allard describes a research project to examine whether an intensive follow-up and recall system improved liver cancer surveillance programs in patients with chronic hepatitis B. On the basis of current recommendations for 6-8 monthly liver ultrasounds and AFPs, optimal screening was defined as having achieved 2 scans every 14 months, sub-optimal screening as one scan every 14 months and poor screening as less than one scan every 14 months.
The intervention consisted of nurses conducting an audit to detect patients requiring HCC surveillance within the clinic patient base, upskilling the healthcare workers in hepatitis B management, and establishing a proactive recall system consisting of a variety of strategies such as calling of patients, sending out of path forms by mail or sending out pre-appointment confirmation texts.
A participation rate of 75% was obtained in this patient cohort yet optimal screening was only achieved in 25% of patients. It was not clear what the baseline of adherence to screening schedules were like prior to the intervention, and thus it is difficult to interpret this result.
An important observation made during this study was that patients often had little understanding of their individual risk of HCC, and that this perhaps impacted on their adherence to screening schedules.
Recommendations included developing a low English literacy tool to help to explain this better to patients, implementing a community awareness program, considering the role of a liver cancer registry, and supporting the development of a more feasible method of screening.
See Nicole's presentation here.