Optimising Surveillance in Hepatocellular Carcinoma: Patient-Defined Obstacles and Solutions

Background and Aims: Six-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis. Surveillance enhances early detection and improves survival. Yet, despite clear benefits, uptake remains low. We aim to identify and explore ways to overcome patient-related barriers to HCC surveillance with the aim of producing invitations for surveillance. Methods: Using the COM-B model of behaviour and a co-design process, we collaborated with patients, liver health charities and advocacy groups, to identify patient-related barriers to attending HCC surveillance. We performed qualitative thematic analysis of coproduction workshops on HCC surveillance to develop information leaflets and surveillance invitations. Results: Twenty-eight participants attended five workshops. Fear of a serious diagnosis and stigma from healthcare professionals were highlighted as main patient-related barriers to attending surveillance appointments. Co-design was used to develop informative, userfriendly, non-judgemental invitations and information regarding HCC surveillance relevant to populations with cirrhosis. Conclusion: We identified potential patient barriers to surveillance uptake and developed patient facing material that directly addressed these barriers to be trialled in the clinic. Targeting patient-specific barriers may increase uptake of surveillance and therefore enhance early diagnosis. Plain language summary: Ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended for those with chronic liver disease, but surveillance uptake remains low. Fear and concern about stigma from healthcare professionals are widespread and act as barriers to surveillance attendance. Through a co-design process, we designed invitations to surveillance alongside informational material, aiming to address the self-reported barriers and motivators to surveillance attendance.