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A Competent Hepatocyte Model Examining Hepatitis B Virus Entry through Sodium Taurocholate Cotransporting Polypeptide as a Therapeutic Target
Published on: May 10, 2022
'We can bear it!' Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B:
Caixia Li1, Xiling Lu2, Jinnan Xiao3
1The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Aims And Objectives:
To explore barriers to hepatocellular carcinoma screening among patients with hepatitis B.
Background:
Hepatitis B-related hepatocellular carcinoma is a major cause of cancer-related mortality globally. A preventive strategy for screening is needed to improve early tumour detection and overall survival. However, utilisation remains suboptimal and barriers are understudied and largely focused on clinical factors.
Design:
A qualitative study based on the preventive health model using phenomenological hermeneutical approach.
Methods:
Face-to-face semi-structured interviews were conducted with 23 hepatitis B patients from November 2020 to February 2021. Interpretative phenomenological analysis was used. The COREQ checklist was followed.
Results:
Four themes were identified: (i) miscognition, (ii) cultural stigma and taboo, (iii) social norms of enduring hardship and (iv) social barriers at the community, health system and policy levels. Patients had misconceptions about inactive carriers, asymptomatic nature of chronic hepatitis B, hepatocellular carcinoma risks and screening recommendations. Influenced by the taboo of hepatocellular carcinoma, stigma against hepatitis B and enduring hardship norms, they perceived screening as divination, avoided utilisation to hide disease status and endured symptoms until they were intolerable. Insufficient community support, a lack of shared decision-making in health systems, and inadequate rural reimbursement policy and hepatocellular carcinoma detection capacity further precluded utilisation.
Conclusions:
Cognitive and sociocultural barriers precluded individuals' intention, utilisation and persistence of hepatocellular carcinoma screening. The results highlight intervention targets for miscognition, stigma, taboo and social norms; propose family-focused, community-based education programs; suggest health systems to introduce decision aids; and inform policymaking and upskilling of physicians in rural areas.
Relevance To Clinical Practice:
Collaborative efforts are needed to improve real-world hepatocellular carcinoma screening, including education to address knowledge deficiencies, psychological counselling to reduce stigma and taboo beliefs, support for shared decision-making and reimbursement policies.
