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Voices of Multi-ethnic Providers in NYC: Health Care for Viral Hepatitis to Prevent Hepatocellular Carcinoma

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Abstract

Worldwide, hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths and the ninth in the US. Hepatitis B and C make up almost 80 % of HCC cases. Based on our Hepatitis Outreach Network screening program data, approximately 40 % of at-risk foreign-born community members who tested positive for viral hepatitis B and/or C did not follow up for additional care. Our aim was to use theory-driven qualitative research to identify barriers and facilitators to follow-up after viral hepatitis diagnosis among these community members from the viewpoint of primary care providers (PCPs). As viral hepatitis is a precursor of liver cancer, timely treatment of the virus has the potential to reduce the incidence and burden of liver cancer. We performed semi-structured key informant interviews with 20 primary care physicians who predominantly serve Korean, Chinese, Egyptian, and Russian communities. Barriers detected included cultural factors commonly seen amongst immigrant populations such as busy work schedules and non-English language. Common facilitators include increased primary care physician involvement and linkages to care within communities in which patients reside. Providers perceived that they are gatekeepers to specialty care for their patients and therefore key persons to engage in viral hepatitis evaluation and management by specialists. This initial study suggests that re-focusing energy into primary care physicians might offer promise for improved care for individuals from immigrant communities who have viral hepatitis to help them engage in care and thereby reduce the burden of liver cancer.

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Acknowledgments and Disclosures

This project was supported by the American College of Gastroenterology and Tisch Cancer Institute. The authors would like to extend thanks to HONE’s community partners, the HONE and Mount Sinai Department of Oncological Sciences’ staff, and our study participants for their insight and support. In particular, the authors are grateful to Danielle Crookes and Karent Zorogastua, coordinators in the Department of Oncological Sciences.

Hyosun Han, Ponni Perumalswami, Lawrence Kleinman, and Lina Jandorf have no relevant financial disclosures.

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Authors and Affiliations

  1. Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Room 11-70, Box 1123, New York, NY, 10029, USA

    Hyosun Han & Ponni V. Perumalswami

  2. Department of Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Lawrence C. Kleinman

  3. Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Lina H. Jandorf

Authors
  1. Hyosun Han
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  2. Ponni V. Perumalswami
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  3. Lawrence C. Kleinman
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  4. Lina H. Jandorf
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Corresponding author

Correspondence to Ponni V. Perumalswami.

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Han, H., Perumalswami, P.V., Kleinman, L.C. et al. Voices of Multi-ethnic Providers in NYC: Health Care for Viral Hepatitis to Prevent Hepatocellular Carcinoma. J Canc Educ 29, 214–223 (2014). https://doi.org/10.1007/s13187-013-0569-7

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  • DOI: https://doi.org/10.1007/s13187-013-0569-7

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