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Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers

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Abstract

Background

Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening.

Methods

We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses.

Results

There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63–96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers.

Conclusions

Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.

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Author information

Authors and Affiliations

  1. Department of Medicine, Mount Sinai Medical Center, Miami, USA

    Mahmoud Mahfouz

  2. Department of Medicine, Palmetto General Hospital, Hialeah, USA

    Harry Nguyen

  3. University of Miami Miller School of Medicine, Miami, USA

    Jonathan Tu

  4. Department of Medicine, University of Miami Miller School of Medicine, Miami, USA

    Carlos R. Diaz, Stefanie Brown & Olveen Carrasquillo

  5. Jackson Memorial Hospital, Miami, USA

    Carlos R. Diaz

  6. Department of Medicine, Infectious Diseases Division, University of Miami Miller School of Medicine, Miami, USA

    Shweta Anjan

  7. Department of Family Medicine, University of Miami Miller School of Medicine, Miami, USA

    Kassandra Bosire

  8. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA

    Olveen Carrasquillo, Paul Martin & Patricia D. Jones

  9. Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA

    Paul Martin & Patricia D. Jones

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  1. Mahmoud Mahfouz
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Correspondence to Patricia D. Jones.

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Mahfouz, M., Nguyen, H., Tu, J. et al. Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers. Dig Dis Sci 65, 2551–2561 (2020). https://doi.org/10.1007/s10620-019-05980-1

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  • DOI: https://doi.org/10.1007/s10620-019-05980-1

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