Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N, Broadway, Room 689, Baltimore, MD 21205, USA.
BMC Health Serv Res. 2012 Oct 30;12:376. doi: 10.1186/1472-6963-12-376.
Liver cancer is a complex and burdensome disease, with Asia accounting for 75% of known cases. Comprehensive cancer control requires the use of multiple strategies, but various stakeholders may have different views as to which strategies should have the highest priority. This study identified priorities across multiple strategies for comprehensive liver cancer control (CLCC) from the perspective of liver cancer clinical, policy, and advocacy stakeholders in China, Japan, South Korea and Taiwan. Concordance of priorities was assessed across the region and across respondent roles.
Priorities for CLCC were examined as part of a cross-sectional survey of liver cancer experts. Respondents completed several conjoint-analysis choice tasks to prioritize 11 strategies. In each task, respondents judged which of two competing CLCC plans, consisting of mutually exclusive and exhaustive subsets of the strategies, would have the greatest impact. The dependent variable was the chosen plan, which was then regressed on the strategies of different plans. The restricted least squares (RLS) method was utilized to compare aggregate and stratified models, and t-tests and Wald tests were used to test for significance and concordance, respectively.
Eighty respondents (69.6%) were eligible and completed the survey. Their primary interests were hepatitis (26%), hepatocellular carcinoma (HCC) (58%), metastatic liver cancer (10%) and transplantation (6%). The most preferred strategies were monitoring at-risk populations (p<0.001), clinician education (p<0.001), and national guidelines (p<0.001). Most priorities were concordant across sites except for three strategies: transplantation infrastructure (p=0.009) was valued lower in China, measuring social burden (p=0.037) was valued higher in Taiwan, and national guidelines (p=0.025) was valued higher in China. Priorities did not differ across stakeholder groups (p=0.438).
Priorities for CLCC in Asia include monitoring at-risk populations, clinician education, national guidelines, multidisciplinary management, public awareness and centers of excellence. As most priorities are relatively concordant across the region, multilateral approaches to addressing comprehensive liver cancer would be beneficial. However, where priorities are discordant among sites, such as transplantation infrastructure, strategies should be tailored to local needs.
肝癌是一种复杂且负担沉重的疾病，亚洲占已知病例的 75%。综合癌症控制需要使用多种策略，但不同的利益相关者对于哪些策略应优先考虑可能存在不同的看法。本研究从中国、日本、韩国和中国台湾的肝癌临床、政策和宣传利益相关者的角度出发，确定了综合肝癌控制（CLCC）的多个策略的优先级。评估了整个地区和整个受访者角色的优先级一致性。
在对肝癌专家进行的横断面调查中，对 CLCC 的优先级进行了检查。受访者完成了几项联合分析选择任务，以对 11 项策略进行优先级排序。在每个任务中，受访者判断两个竞争的 CLCC 计划中的哪一个（由策略的互斥且穷尽子集组成）将产生最大的影响。因变量是所选的计划，然后将其回归到不同计划的策略。使用受限最小二乘法（RLS）方法比较总体和分层模型，并使用 t 检验和 Wald 检验分别测试显著性和一致性。
80 名符合条件的受访者（69.6%）完成了调查。他们的主要兴趣是肝炎（26%）、肝细胞癌（HCC）（58%）、转移性肝癌（10%）和移植（6%）。最受欢迎的策略是监测高危人群（p<0.001）、临床医生教育（p<0.001）和国家指南（p<0.001）。除了三个策略外，大多数优先级在各地点之间是一致的：中国对移植基础设施的重视程度较低（p=0.009），台湾对衡量社会负担的重视程度较高（p=0.037），中国对国家指南的重视程度较高（p=0.025）。利益相关者群体之间的优先级没有差异（p=0.438）。
亚洲综合肝癌控制的优先事项包括监测高危人群、临床医生教育、国家指南、多学科管理、公众意识和卓越中心。由于大多数优先级在该地区相对一致，因此采用多边方法解决综合肝癌问题将是有益的。但是，在优先事项在地点之间不一致的情况下，例如移植基础设施，策略应根据当地需求进行调整。
