Clinical care in hepatocellular carcinoma: A mixed methods assessment of experiences and challenges of oncology professionals

Abstract

Introduction Healthcare providers (HCPs) may face numerous dilemmas in optimally screening, diagnosing, and treating patients with, and/or at risk for, hepatocellular carcinoma (HCC). This study aimed to achieve a greater understanding of the challenges in HCC care which in turn could delineate HCP educational opportunities within this oncologic sub‐specialty. Methods A mixed‐methods approach was used to identify practice gaps and clinical barriers experienced by US‐based medical oncologists, hepatologists, oncology physician assistants, oncology nurse practitioners, and interventional radiologists involved in HCC care. The qualitative (semi‐structured interview) and quantitative (survey) data collection approaches were deployed sequentially with findings subsequently triangulated. Results A total of 214 HCPs participated in this study. Analysis revealed challenges related to screening and diagnosing HCC, specifically in applying appropriate screening guidelines, and the optimal use and decisions related to diagnostic imaging and biopsy. Issues related to treatment selection included the application of existing HCC guidelines in treatment decision‐making, weighing risk/benefit ratios of various antineoplastics regimens (i.e., tyrosine kinase inhibitors‐TKIs, immunotherapy agents, chemotherapy), sequencing therapies, potential toxicity management, and optimally educating patients about their HCC. Conclusion These findings highlight the educational needs of those involved in HCC care and provide a starting point for clinicians to both reflect on their practice and identify opportunities to enhance communication within the HCC team and between provider and patient. There is an opportunity to optimize continuing professional development interventions that address the identified gaps in clinical practice specifically related to teamwork and interdisciplinary communication.

Health Services Research: A Review for the Interventional Radiologist

“…They also demonstrated issues related to treatment selection within existing HCC guidelines and with optimal education to patients about their HCC. 22 All of these findings together provide insights into why patients are not being cared for like we would want them to be, based on our quantitative understanding of the literature and existing guidelines, generating evidence for interventions to improve outcomes.…”

“…18 An example of mixed methods research is an assessment, by Jacobs et al, of experiences and challenges of oncology professionals in clinical care of HCC. 22 Their primary objective was to identify and categorize team-based clinical practice gaps and challenges experienced by U.S.-based medical oncologists, hepatologists, oncology physician assistants and nurse practitioners, and interventional radiologists. They did this by sequential use of a qualitative exploration phase (interviews with open-ended questions to explore healthcare providers' perceptions about screening, diagnosis, and treatment of HCC) followed by a quantitative validation phase (online survey).…”