Understanding Barriers and Needs in Liver Cancer Prevention: A Qualitative Study of a Houston Community Clinic
Introduction
Hepatocellular carcinoma (HCC) is a major cause of mortality in Texas; Texas is the state with the highest incidence of HCC, and this is true across all major racial/ethnic groups. As the fastest rising cause of cancer mortality, HCC is projected to be among the top three causes of cancer mortality by 2030 worldwide. Survival rates for patients with HCC are low due to late diagnosis and limited treatment options, so preventing HCC by addressing various HCC risk factors should be a top priority. Community and organizational needs assessments can serve to address factors associated with high risk for HCC, such as tobacco and alcohol use. This qualitative study aims to assess organizational needs and capacity, and patient barriers, needs, and intervention preferences for HCC prevention.
Methods
The HOPE Clinic serves a racially, ethnically, and economically diverse patient population in Houston, Texas, many of whom are uninsured and at high risk for HCC. A multi-level data collection strategy was conducted that consisted of both focus groups with HOPE clinic providers/staff, as well as with HOPE clinic patients. Focus group domains included: clinical barriers, patient needs, intervention preferences, healthy living barriers, and liver health knowledge. Using transcripts from the focus groups, we conducted thematic and narrative analyses to understand the needs and preferences for a liver disease management intervention for patients at risk for HCC. Atlas.ti 8.0 was used for the development of codes and themes and for qualitative analyses to inform future intervention development.
Results
Thematic analysis of patient focus groups revealed patients' perceived time limitations, lack of discipline, lack of screening incentives, and low healthy living literacy as barriers to changing their behavior. Most patients preferred the option of a weekly virtual intervention held on weekday afternoons that focused on nutritional and exercise-focused material. Analysis of provider focus groups revealed provider preference for a longitudinal face-to-face intervention with focuses on lifestyle modifications and alcohol use reduction. Many providers also identified a lack of access to specialized medical services or health care professionals such as nutritionists as hindrances to patient awareness of HCC risk factors associated with lifestyle.
Conclusion
These findings highlight the need for comprehensive interventions to overcome barriers to lifestyle changes and promote awareness of HCC risk factors, such as tobacco and alcohol use, among a racially, ethnically, and economically diverse patient population. By tailoring interventions based on patient preferences for virtual approaches and addressing gaps in health literacy and access to specialized medical services, we can develop effective strategies to combat HCC and improve patient outcomes. The partnership between HOPE clinic and MD Anderson Cancer Center for this project shows the feasibility of a community partnership program for assessing community needs in relation to cancer prevention.