Background
Methods
Focus groups (stage 2)
Structured prioritisation exercise (stage 3)
Expert panel (stage 4)
Results
Focus groups (stage 2)
Focus Group | Participants (n) | Participant type and background | Gender |
---|---|---|---|
Group 1 | 2 | • Clinician - specialist (hepatology) • Clinician - nurse (hepatology) | M F |
Group 2 | 2 | • Clinician/ researcher (hepatology) • Clinician/ researcher (chronic disease, incl. hepatology and cancer) | F F |
Group 3 | 3 | • Consumer and patient advocate (chronic disease and Aboriginal and Torres Strait Islander health) • Consumer and patient advocate (hepatology) • Clinician - nurse (hepatology) | F M F |
Theme | Attribute of screening program |
---|---|
Convenience and ease of access | Patient receives a reminder or prompt to undertake screening |
Ease of making an appointment to be screened | |
Travel distance to screening location | |
Out of pocket costs for the patient | |
Screening is integrated into a routine care appointment | |
Health worker and consumer interaction | Positive patient experience with staff (e.g. friendly, culturally safe, and non-judgemental) |
Information on screening process and/or value of being screened comes from a trusted source | |
Consumer motivation | Patients experience of pain/discomfort during procedure |
Severity of the condition, current symptoms, and a patient’s other co-morbidities/conditions | |
Likelihood that additional testing or invasive testing is required | |
Availability and effectiveness of treatment options | |
Screening test and process | Waiting time for results |
Quality of the test and results (e.g. accuracy, consistency) | |
System level | Screening data is part of a registry to inform population health decisions e.g. where to put more services |
Staff are trained and knowledgeable about the condition and screening process |
“Easy to do. Easy to book. Easy to park… There’s no cost involved… Make it easy for them to take the option to do it rather than not do it.“ Clinician3.
“When you live quite a distance … you’ve got to take a bus and a boat and a bus and a train and a walk to get to the hospital.” Consumer1.
“I think setting’s important… perform screening for advanced fibrosis in healthcare settings where people are already engaged… there’s definitely a convenience factor… 100%, yeah.“ Clinican1.
“And patients could get reminders. Like I get a reminder for my cervical cancer screening, breast screening.“ Clinician4.
“People don’t like travelling and certainly don’t like paying parking fees at hospitals and all the things like that. So, the cheaper and more local it is (the better).“ Clinician1.
“If there’s a cost involved then that’s going to be, okay… it’s going to be a toss-up between do I pay my bills and buy food, or do I do this test?“ Consumer1.
“I was getting put into a basket, into a pigeonhole, treating us all like we were drinkers or drug users, and there’d be a lot of people who can relate to that.“ Consumer2.
“Possibly the factors that often lead to liver disease… So, alcohol and obesity and illicit drug use… for too long it’s perhaps been seen in a negative light.“ Clinician4.
“So that really welcoming environment where it’s culturally appropriate and safe, and non-judgmental is a really key component of making it – you want to come in and see the service.“ Consumer2.
“Having the health staff that are doing the test, culturally aware, for our mob.“ Consumer1.
“I just don’t see much awareness around it (liver disease) …where I live anyway, yeah.“ Consumer2.
“So, it was a trusted source of information and that sort of encouraging from someone that they know …removes that sort of fear of the unknown.“ Clinician2.
“Still believe it comes down to working with what we have in the communities, work with leaders, leaders of communities, because that’s where you get the respect.“ Consumer2.
“Some of the patients said that, if only I knew somebody that had already gone through this, they could have told me what to expect or even just to know that there was someone else out there that’s going through the same thing.“ Consumer1.
“We had people like (Rugby player 1) supporting us, (Rugby player 2) was supporting us… I reckon with the awareness around anything – it can be fatty liver disease, hepatitis, whatever, you’ve got to have Community Champions out there.“ Consumer2.
“It doesn’t hurt; it doesn’t scare people.“ Clinician3.
“Mainly physical. I mean, you know, people won’t like to turn up at colonoscopies and endoscopies because it’s uncomfortable… for something like a blood pressure or a Fibroscan, it doesn’t even involve the discomfort of a blood test… it’s an ideal test in that regard.“ Clinican1.
“I think symptoms play a part as well. You know, this is – people don’t often know they’ve got NAFLD or Hep C or Hep B until something presents, and so it’s, you know, “Who cares?“ Clinician2.
“They’re already dealing with a certain amount of comorbidity, and, I guess, actively undergoing a test that might lead to another diagnosis is – probably puts them off a little bit.“ Clinician2.
“This is one of the problems associated with liver disease… (it) progresses silently until very advanced stage of liver disease is reached… if someone is otherwise well… you need to consider the risk versus the benefit of undertaking a procedure… if the stage of disease is unclear or the ethology of disease is unclear and a liver biopsy is needed, that’s quite an invasive test which carries a potential morbidity and even mortality.” Clinican3.
“Firstly, screening Hepatitis C, fantastic, because we have a treatment and that treatment’s highly efficacious, it works, it’s easy to take, and so…. That gets over the barriers to implementing this sort of screening programme… NAFLD is a different kettle of fish. … at the moment we don’t have an effective treatment for NAFLD, other than weight loss and exercise, and if it was that easy, we wouldn’t have a problem of NAFLD and diabetes in the first place.“ Clinician1.
“A lot of people that get diagnosed with Hepatitis think it’s a death sentence…you’d be surprised how many didn’t even know… a simple tablet can cure you in days” Consumer2.
“there’s lots and lots of data now that we can believe in [specific screening test] results, as long as it’s done properly by a trained operator in a patient who’s fasted and things like that, then we have a lot of faith in the numbers” Clinician1.
“You want your results as soon as you can. Because otherwise you stress about it.” Clinician3.
“When you think breast screening… that brings a little bit of anxiety… I’ve had a lot of investigations done… and you do the test, and you wait for like 24 hours and you’re kind of like ’oh my gosh – that’s the end of me’, and then it’s ok.” Clinician4.
“Probably an important thing that some central repository where everyone, every clinic, would be able to access the images for a particular patient. Like someone has got a little nodule... (is it) the same size as six months later or a year later?”
“We can’t measure easily who is getting screened (for liver disease) and who is not...you can certainly get that on breast screening and cervical cancer screening…”
“There is no registry... There is no Medicare item specifically for that… who’s getting – where is the gap?”
“I guess one of the problems – so that at the moment there’s quite a spectrum of quality, of imaging, in the community.”
Prioritisation exercise
Score | Rank | Attribute |
---|---|---|
4.97 | 1 | Ease of making an appointment to be screened |
5.47 | 2 | Quality of the test and results (accuracy, consistency) |
6.20 | 3 | Information on screening process and/ or value of being screened, comes from a trusted source |
6.27 | 4 | Patient receives a reminder or prompt to undertake screening |
6.53 | 5 | Positive patient experience with staff (i.e. friendly, culturally safe, non-judgemental) |
6.87 | 6 | Staff are trained and knowledgeable about the condition and screening process |
7.00 | 7 | Screening is integrated into a routine care appointment |
7.17 | 8 | Travel distance to screening location |
7.57 | 9 | Out-of-pocket costs for the patient |
9.27 | 10 | Availability and effectiveness of treatment options |
9.30 | 11 | Severity of the condition, current symptoms, and a patient’s other co-morbidities/ conditions |
9.37 | 12 | Physical experience of pain/ discomfort during screening procedure |
9.93 | 13 | Waiting time for results |
12.03 | 14 | Likelihood that additional testing/ invasive testing is required |
12.07 | 15 | Screening data is part of a registry to inform population health decisions (e.g. where to put more services) |
Expert panel
Attribute | Level 1 | Level 2 | Level 3 |
---|---|---|---|
Screening conduct | Nurse at local community health clinic | GP at your usual GP clinic | Specialist in hospital outpatient clinic |
Quality and accuracy of the test results | 85% accurate - For every 100 people who had a negative result, 15 would be incorrect and should have been positive | 90% accurate - For every 100 people who had a negative result, 10 would be incorrect and should have been positive | 95% accurate - For every 100 people who had a negative result, 5 would be incorrect and should have been positive |
Cost to the patient/ consumer | $0 (includes out of pocket costs such as parking, as well as lost income for time taken to undertake screening appointment) | $80 (includes out of pocket costs such as parking, as well as lost income for time taken to undertake screening appointment) | $250 (includes out of pocket costs such as parking, as well as lost income for time taken to undertake screening appointment) |
Wait time to appointment for screening | 2 weeks | 2 months | 6 months |
Source of information about importance of screening and screening process | Screening information is detailed and comes from a well trusted source e.g. community member/ health professional you have a good relationship with discusses screening with you and provides a detailed flyer | Screening information comes from a source which you would have a moderate amount of trust e.g. community member/ health professional that you know moderately well quickly tells you that you need to be screened and hands you a short flyer | Screening information is sent to you from a source where you have limited familiarity or trust e.g. you receive a generic text, email or letter about screening |