Psychosocial impact of false-positive surveillance for hepatocellular carcinoma: a qualitative study

Biannual ultrasound-based hepatocellular carcinoma (HCC) surveillance is standard practice for individuals with cirrhosis and subgroups with non-cirrhotic hepatitis B. While this practice improves cancer-related survival, the detection of false-positive results can lead to additional testing which poses both physical and psychosocial risks. Our study explored the psychosocial consequences of false-positive ultrasound results in participants undergoing HCC surveillance.

We performed a qualitative study with semi-structured interviews to understand the psychosocial impact of participants who received a false-positive ultrasound result during HCC surveillance until no new themes emerged. Key themes were analysed using the Framework Approach.

Ten participants with cirrhosis or non-cirrhotic hepatitis B were recruited. Most had a poor understanding of the role of ultrasound in HCC surveillance. Some participants experienced significant anxiety with existential concerns impacting family and work life. Others remained uninformed about the risk for HCC and did not experience significant psychosocial impacts. The lack of understanding about the role of surveillance and the potential for false positives contributed to unpredictable psychosocial consequences. Despite experiencing surveillance-related harm, all participants wished to continue regular surveillance.

Our findings highlight a need for improved health literacy about the purpose and potential harms of HCC surveillance. Optimising surveillance protocols to minimise false-positive findings may also further alleviate physical and psychosocial harm.