Timing and Method of Patient-Provider Communication for Abnormal Hepatocellular Carcinoma Screening Results in Cirrhosis.

Abstract

Patients with cirrhosis undergo frequent abdominal imaging including semiannual hepatocellular carcinoma (HCC) screening, with results released immediately via the patient portal. We characterized time from patient review to patient-provider communication (PPC) for patients with abnormal liver imaging results. We identified patients with cirrhosis enrolled in the patient portal with a new abnormal liver lesion (LI-RADS, LR) on ambulatory liver ultrasound (US) or multiphasic computed tomography/magnetic resonance imaging. Imaging findings were grouped into low-risk (US-2, LR-2), intermediate-risk (US-3, LR-3), and high-risk (LR-4, LR-5, LR-M, LR-TIV) results. We extracted three date-time events from the electronic health record, including result release to the patient, patient review of the result, and result-related PPC. We compared communication methods and the median time with PPC after patient review of results between groups. The cohort included 133 patients (median age, 62 years, 56% male) with 34 (25.6%) low-risk, 61 (45.9%) intermediate-risk, and 38 (28.6%) high-risk results. PPC for high-risk results was predominantly via telephone calls (60.5%), whereas portal messages were most commonly used for low- and intermediate-risk results (61.8% and 45.9%, respectively; <i>P</i> < .001). For patients who reviewed their result on the portal, most (79.3%) reviewed the result before PPC, among whom the median time between review and PPC was 55.8 (IQR, 22.0-219.0), 167 (IQR, 42.7-324.0), and 47.3 (IQR, 25.8-78.8) hours for low-, intermediate-, and high-risk results, respectively (<i>P</i> = .02). Portal-based review of abnormal imaging results by patients before provider communication is common, including results concerning a new HCC diagnosis. Further studies are needed to evaluate patient-reported outcomes, such as psychological distress, associated with this method of disclosing cancer-related results.