The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing worldwide. Cirrhotic patients are recommended by the American Association for the Study of Liver Disease (AASLD) to receive HCC screening and surveillance every 6 months to a year. The purpose of this study was to identify the current screening and surveillance patterns for cirrhotic patients with HCC in clinical practice. Hepatocellular carcinoma can be detected by radiological studies in addition to laboratory testing. It is important to implement the AASLD screening guidelines, as early identification might decrease the mortality rate of patients with cirrhosis and HCC. The research question guiding this study was: What are the screening patterns of cirrhotic patients diagnosed with cirrhosis and HCC that have been referred to the Hepatology Division? A retrospective, descriptive, cross-sectional design was used for this study. Data were collected from subjects who were referred to a Specialty Hepatology Division for evaluation and treatment. Approval was obtained from the IRB. Cirrhotic patients diagnosed with HCC meeting the inclusion and exclusion criteria were used in this study. The aim of the study was to identify the clinical patterns of practitioners screening for HCC in cirrhotic patients. Validity and reliability for the data collection tool was not established. Variables that were studied included demographic data, etiology of cirrhosis, type of HCC screening, time increments of screening, and size of tumor at the time of diagnosis. The data were analyzed with the use of crosstabs, frequency, and correlation statistics. Despite the recommended HCC screening and surveillance guidelines cirrhotic patients were not screened. The different screening patterns that were identified were none, sporadic, and annual (every 6 months to 1 year). The patterns differed by the practitioner managing the patient. Also, cirrhosis was diagnosed late in the disease process, although many of the patients are followed by gastroenterologists. It can be assumed that the late diagnosis of cirrhosis was another factor that was preventing the implementation of HCC screening and surveillance. Implications for practice were identified. Practitioners are responsible for performing HCC screening and surveillance of cirrhotic patients based on the recommended guidelines of the AASLD for the management of cirrhotic patients and the detection of small lesions. Only 33% of the patients were screened with the use of ultrasound, and 43% were screened with alpha-fetoprotein. The lesions that were diagnosed were larger in the non-screened patients than the screened patients. The Hepatology Division was the only setting that was screening the patients based on the recommended guidelines. The recommendation based on the results of this study is for all cirrhotic patients to be managed by hepatology services if one is available.
| Identifer | oai:union.ndltd.org:ucf.edu/oai:stars.library.ucf.edu:etd-5230 |
| Date | 01 January 2010 |
| Creators | Scott-Castell, Shelly-Ann |
| Publisher | STARS |
| Source Sets | University of Central Florida |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Electronic Theses and Dissertations |
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