Community liver health champion support can optimise the engagement of underserved patients with hepatocellular cancer surveillance-results of a 1 year regional pilot

Walker, Tanya, Glyn-Owen, Kate, Saison, Chris, Perumal, Mhukti, Gardner, Kelly, Wilson, Wendy, Parsons, Heather and Buchanan, Ryan (2024) Community liver health champion support can optimise the engagement of underserved patients with hepatocellular cancer surveillance-results of a 1 year regional pilot. Journal of Hepatology, 80 (Suppl. 1), S647-S647, [SAT-447]. (doi:10.1016/s0168-8278(24)01868-3).

Abstract

Background and aims: hepatocellular carcinoma (HCC) is an important complication of chronic liver disease and HCC is expected to become the 3rd most common cause of cancer death world-wide by 2030. Incident HCC and death from HCC are skewed towards marginalized and socio-economically deprived populations. Engagement with HCC cancer surveillance in these populations is poor. The aim of the project was to develop and implement a community champions programme to support under-served patients access HCC surveillance.

Method: the programme was funded by NHS England and implemented in 3 acute hospital trusts in Wessex (UK). Each trust appointed an HCC service navigator, and three liver health champions to work across trusts in the community. Champions had a lived experience of marginalisation or working with under-served populations and were tasked with maximising attendance at ultrasound appointments. Eligible patients were enrolled into the programme if they were 1)known to need HCC surveillance but had not had a scan for >12months, 2) highlighted at diagnosis by the clinical team as likely to need support to attend or 3) had a recent record of not attending an appointment with the Hepatology service. Descriptive statistics were calculated using independent samples t-test and chi-squared tests in SPSS for mac version 28.0.1.1.14.

Results: across two acute trusts, 299 eligible patients were added to the Champions programme in 9 months. Due to data governance and staffing challenges the 3rd hospital did not commence the programme in this time frame. The majority were enrolled due to non-attendance at liver US for >12 months prior (n = 158, 53%). Most patients were male (n = 193, 65%) and the mean age was 56 years (SD12). The most common underlying aetiology was alcohol (n = 94,31%).Navigator contact was made with 189 (63%) patients. 180 (95%) of these patients attended for a scan in a mean follow-up of 4 months.66 patients were referred for community champion support and 41/180 (23%) only attended with their direct input. The 119/299 patients who did not have a scan were significantly more likely to be from an ethnicity other than white British (p < 0.01; 17% vs 11%) but there was no significant difference in index of multiple deprivation, age, sex, or aetiology. Champions overcame barriers including language, health literacy and homelessness. Their detailed mechanism of effect is subject to an ongoing qualitative study. Referral for champion support was significantly associated with a diagnosis of HCV (p < 0.01).

Conclusion: a programme to support underserved patients attend HCC surveillance imaging can be implemented at a regional level and leads to high rates of attendance in patients previously disengaged from care. Further evidence describing the sustainability of benefit and cost-effectiveness is important to support the implementation of a national service.

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Contributors

Author: Kate Glyn-Owen

Author: Ryan Buchanan

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