Factors influencing physicians' screening behavior for liver cancer among high-risk patients.

BACKGROUND

Little is known about physicians' screening patterns for liver cancer despite its rising incidence.

OBJECTIVE

Describe physician factors associated with liver cancer screening.

DESIGN

Mailed survey.

PARTICIPANTS

Physicians practicing in family practice, internal medicine, gastroenterology, or nephrology in 3 northern California counties in 2004.

MEASUREMENTS

Sociodemographic and practice measures, liver cancer knowledge, attitudes, and self-reported screening behaviors.

RESULTS

The response rate was 61.8% (N = 459). Gastroenterologists (100%) were more likely than Internists (88.4%), family practitioners (84.2%), or nephrologists (75.0%) to screen for liver cancer in high-risk patients (p = 0.016). In multivariate analysis, screeners were more likely than nonscreeners to think that screening for liver cancer reduced mortality (odds ratio [OR] 1.60, CI 1.09-2.34) and that not screening was a malpractice risk (OR 1.88, CI 1.29-2.75). Screeners were more likely than nonscreeners to order any screening test if it was a quality of care measure (OR 4.39, CI 1.79-10.81).

CONCLUSIONS

Despite debate about screening efficacy, many physicians screen for liver cancer. Their screening behavior is influenced by malpractice and quality control concerns. More research is needed to develop better screening tests for liver cancer, to evaluate their effectiveness, and to understand how physicians behave when there is insufficient evidence.