Abstract B002: Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees
Authors: Jones Patricia D. , Mahfouz Mahmoud , Nguyen Harry , Tu Jonathan , Diaz Carlos R. , Anjan Shweta , Brown Stefanie , Bosire Kassandra , Martin Paul M. , Carrasquillo Olveen 
Published: August 2020

Abstract
Background: Hepatitis B (HBV), a leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the United States. Undiagnosed HBV infection precludes HCC screening and contributes to late-stage presentation and decreased survival. Previously, we reported low HBV screening rates in persons from endemic countries. Barriers to screening include lack of insurance, limited diffusion of guidelines, and provider uncertainty. We aimed to assess knowledge about HBV and HCC screening and to explore barriers to HCC screening among trainees from three unique institutions.
Methods: We administered a survey to trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We used univariate, bivariate, and Pearson's chi-squared analyses to assess knowledge and barriers using clinical vignettes.
Results: There were 183 respondents born in 36 countries. Median age was 31 years. The sample was 35% Hispanic, 29% White, 18% Asian, 9% Black, 7% other, 2% multiracial and 52% male. Training department was Internal Medicine, 71%, Family Medicine, 11%, Infectious Diseases (ID), 6%, or Gastroenterology (GI), 7%. The perceived burden of HBV was low; 2/3 stated HBV affects &lt;5% of the patient population, 59% correctly estimated national HBV prevalence and 25% correctly estimated global prevalence. In vignettes with behavioral risk factors (e.g., intravenous drug use), trainees correctly advised screening, 63-96%. However, when birthplace was the only risk factor, correct responses ranged from 33-53%. Overall, 48% chose an incorrect combination of HBV screening tests. Respondents from HBV-endemic countries were no more likely to screen for HBV. Knowledge of HBV treatment indications was poor. More fellows (ID/GI) correctly recommended treatment than residents, p &lt;0.01. Barriers to HBV screening were lack of education among health care workers, limited expertise in screening of immigrants, and limited patient education. Barriers to treatment were cost, knowledge about HBV regimens, and provider comfort. Respondents were more likely to recommend HCC screening in cirrhotic patients vs. noncirrhotic HBV patients, even when indicated. Only 43% of participants recognized that HCC screening is unnecessary in patients with acute HBV and 53% either recommended HCC screening or indicated uncertainty in noncirrhotic patients with resolved HBV infection. Respondents indicated they would screen for HCC if strong evidence suggested a mortality benefit or if recommended by a national organization. Key barriers to screening were uncertainty or lack of awareness about HCC guidelines and patient financial barriers.
Conclusions: In a diverse sample of trainees, knowledge of HBV and HCC screening recommendations is suboptimal. Efforts to broadly disseminate guidelines through targeted educational interventions are needed as responses confirm that HCC screening indications, especially in HBV, are not universally known.
Citation Format: Patricia D. Jones, Mahmoud Mahfouz, Harry Nguyen, Jonathan Tu, Carlos R. Diaz, Shweta Anjan, Stefanie Brown, Kassandra Bosire, Paul M. Martin, Olveen Carrasquillo. Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B002.