Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multisite Conjoint Analysis

Authors

• Karissa D Kao
• Jonathan P Troost
• Ju Dong Yang
• Reena Salgia, Henry Ford HealthFollow
• Sean A Woolen
• Neil Mehta
• Maarouf A Hoteit
• Prasun K Jalal
• Karim Seif El Dahan
• Darine Daher
• Lisa Quirk
• Nishi Patel
• Anish Nayak
• Jasmine Gamez
• Manaf Alsudaney
• Perla Hernandez
• Megha Bhongade
• Amit G Singal
• Neehar D Parikh

Recommended Citation

Kao KD, Troost JP, Yang JD, Salgia R, Woolen SA, Mehta N, Hoteit MA, Jalal PK, El Dahan KS, Daher D, Quirk L, Patel N, Nayak A, Gamez J, Alsudaney M, Hernandez P, Bhongade M, Singal AG, Parikh ND. Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multi-site Conjoint Analysis. Am J Gastroenterol. 2026.

Document Type

Article

Publication Date

4-10-2026

Publication Title

The American journal of gastroenterology

Abstract

INTRODUCTION: Several emerging modalities are available for hepatocellular carcinoma (HCC) surveillance; however, patient preferences for surveillance tests-particularly across key subgroups such as race/ethnicity, income, and education level-are poorly characterized.

METHODS: We conducted a choice-based conjoint survey among patients with cirrhosis and chronic hepatitis B undergoing HCC surveillance (from 2022 to 2024) at 7 centers in the United States. Participants were presented with 15 scenarios, where they chose between surveillance modalities based on test attributes.

RESULTS: We included 649 patients, with a median age of 60 years, 51% male, 60% White, 10% Black, and 20% Hispanic. The cohort reflected substantial socioeconomic variation including 12% with Medicaid and 38% with Medicare. The highest priority attribute was surveillance benefits (42.9%; 95% confidence interval [CI] 40.6%-45.1%), followed by financial harms (19.4%; 95% CI 18.1%-20.7%). Patients placed less priority on test logistics (12.3%; 95% CI 11.5%-13.2%), test location (9.2%; 95% CI 8.5%-10.0%), test duration (8.3%; 95% CI 7.8%-8.7%), and physical harms (7.9%; 95% CI 7.2%-8.6%). In subgroup analyses, Black participants placed significantly lower importance on surveillance benefits and higher importance on financial harms ( P < 0.001) and test duration ( P = 0.001) compared with White participants. Hispanic participants also prioritized financial harms more than non-Hispanic participants ( P < 0.001), a pattern consistent with cost-related concerns seen across other lower socioeconomic status (SES) subgroups. Lower SES individuals with below a high school education ( P = 0.01), Medicaid insurance ( P = 0.001), and income below $25,000 ( P < 0.001) assigned greater importance to financial harms and less to surveillance benefits.

DISCUSSION: Patients with undergoing HCC surveillance prioritize surveillance test sensitivity; however, results vary by race, ethnicity, and SES. Improving access by reducing financial and logistical barriers through shared decision-making may enhance surveillance, particularly when modalities present with similar effectiveness.

PubMed ID

41979434

ePublication

ePub ahead of print