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Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of
Mahmoud Mahfouz1, Harry Nguyen2, Jonathan Tu3
1Department of Medicine, Mount Sinai Medical Center, Miami, USA.
Insights
Hepatitis B (HBV) and liver cancer (HCC) screening knowledge is insufficient among medical trainees. Educational interventions are crucial to improve guideline dissemination and patient outcomes.
Area of Science:
- Hepatology
- Oncology
- Medical Education
Background:
- Hepatitis B virus (HBV) is a primary cause of hepatocellular carcinoma (HCC) globally, with significant impact on US minority populations.
- Undiagnosed HBV hinders timely HCC screening, leading to late-stage diagnoses and reduced survival rates.
- Barriers to screening include lack of insurance and inadequate dissemination of clinical guidelines.
Purpose of the Study:
- To evaluate medical trainees' knowledge of HBV and HCC screening indications.
- To identify barriers encountered in screening for HBV and HCC.
Main Methods:
- A survey was administered to 183 medical trainees from three major hospitals.
- Knowledge was assessed using clinical vignettes, with data analyzed via bivariate and Chi-squared tests.
Main Results:
- Only 59% accurately estimated national HBV prevalence, and 25% global prevalence.
- Trainees showed higher accuracy in screening recommendations for behavioral risk factors (63-96%) versus birthplace (33-53%).
- Perceived barriers included limited expertise in immigrant screening, patient education deficits, guideline uncertainty, and financial constraints.
Conclusions:
- Medical trainees demonstrate suboptimal knowledge of HBV and HCC screening guidelines.
- Targeted educational interventions are necessary to enhance guideline dissemination and improve screening practices.
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.
