Exploring the Role of Patient Preferences in Hepatocellular Carcinoma Treatment Decisions: A Qualitative Study

Andrew M Moon^{1

2}, Daniel Richardson^{2

3}, Gabriel V Lupu¹, Donna M Evon¹, Hanna K Sanoff^{2

4}, Jessica Carda-Auten^{2

5}, Randall Teal^{2

5}, Myra Waheed^{2

5}, Ethan Basch^{2

4}, David M Mauro⁶, Ted K Yanagihara^{2

7}, David A Gerber⁸, Neil D Shah¹, Oren K Fix¹, Hersh Shroff¹, Tammy Triglianos⁴, Jonathan D Sorah^{2

4}, Jingquan Jia^{2

4}, Ashwin Somasundaram^{2

4}, Lynne I Wagner^{2

9}, Michael D Kappelman¹⁰, Matthew Schooler¹¹, Julia R Phillips¹², Hiwot A Ekuban¹², Ariel E Sanderford¹², A Sidney Barritt 4th¹

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
³ Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁴ Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁵ Connected Health Applications and Interventions (CHAI) Core, University of North Carolina, Chapel Hill, NC, USA.
⁶ Division of Interventional Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁷ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
⁸ Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
⁹ Department of Health Policy and Management, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁰ Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina, Chapel Hill, NC, USA.
¹¹ Division of Abdominal Transplant, University of North Carolina, Chapel Hill, NC, USA.
¹² Center for Esophageal Diseases & Swallowing (CEDAS), University of North Carolina, Chapel Hill, NC, USA.

PMID: 40453415
PMCID: PMC12123149
DOI: 10.1177/23814683251340055

Exploring the Role of Patient Preferences in Hepatocellular Carcinoma Treatment Decisions: A Qualitative Study

Andrew M Moon et al. MDM Policy Pract. 2025.

. 2025 May 29;10(1):23814683251340055.

doi: 10.1177/23814683251340055. eCollection 2025 Jan-Jun.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
³ Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁴ Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁵ Connected Health Applications and Interventions (CHAI) Core, University of North Carolina, Chapel Hill, NC, USA.
⁶ Division of Interventional Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁷ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
⁸ Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
⁹ Department of Health Policy and Management, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁰ Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina, Chapel Hill, NC, USA.
¹¹ Division of Abdominal Transplant, University of North Carolina, Chapel Hill, NC, USA.
¹² Center for Esophageal Diseases & Swallowing (CEDAS), University of North Carolina, Chapel Hill, NC, USA.

PMID: 40453415
PMCID: PMC12123149
DOI: 10.1177/23814683251340055

Abstract

Background. Hepatocellular carcinoma (HCC) treatment decisions are becoming increasingly complex as new treatment options emerge. Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, improve treatment development, and inform HCC treatment guidelines. We performed a qualitative study involving patients with HCC and medical providers to assess the role of patient preferences in HCC treatment choices. Methods. Patient participants included those with HCC seen within a single tertiary care center. Provider participants involved physicians and advanced practice providers who cared for patients with HCC from a single center. Baseline and posttreatment patient interviews were conducted by trained qualitative research experts, informed by semi-structured interview guides, and analyzed using thematic analysis with pilot-tested codebooks. Summaries included a narrative description of the themes and subthemes that emerged related to each code, and illustrative quotes were used to highlight each theme. Results. The baseline interview involved 30 patients with HCC (22 of whom participated in follow-up interviews) and 10 providers who cared for patients with HCC. Patients identified factors considered when making treatment decisions included provider confidence and experience, patient prior cancer experiences, other health issues, and faith. Providers primarily discussed the role of Barcelona Clinic Liver Cancer stage, liver function, performance status, and eligibility of liver transplantation in making treatment recommendations. There was general agreement among providers that there is a need to better understand the role of patient values to improve care for HCC. Limitations. Qualitative interviews were limited to patients and providers from a single center. Conclusions. This qualitative study provided information on the variety of values considered by both patients and providers in HCC treatment decisions and the importance of considering tradeoffs of efficacy, toxicity, and inconvenience/costs.

Highlights: Hepatocellular carcinoma (HCC) treatment decisions are often complex and may become increasingly so as new treatment options emerge.Improved understanding of tradeoffs and patient preferences in treatment decisions will enhance patient-provider discussions, facilitate patient-centered trials to develop new treatments, and inform HCC treatment guidelines.This qualitative study of patients and providers provided information on the values considered in HCC treatment decisions and the importance of considering the tradeoffs of efficacy, toxicity, and inconvenience/costs.These insights can be used to develop preference elicitation tools, perform large-scale preference elicitation surveys, and systematically assess and incorporate patient preferences into treatment decisions.

Keywords: choice; liver cancer; values.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AMM is a consultant for TARGET RWE, Intercept Pharmaceuticals, Eisai, and AstraZeneca. Research funding (to the institution) was received from DCN Diagnostics. EB received research funds to the institution from the National Cancer Institute and the Patient-Centered Outcomes Research Institute. He has received personal fees as a scientific advisor to AstraZeneca, Resilience, Verily, and Navigating Cancer. TT served on Pfizer’s ad board. JJ served as a consultant or advisor to AstraZeneca and Cardinal Health and received research funding or contracted research for Roche, Genentech, and AstraZeneca. ASB is a consultant for Target-RWE, Madrigal, Life-Edit, Boehringer Ingelheim, and Merck. All other authors declared no additional disclosures or potential conflicts of interest. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: financial support for this study was provided in part by an AASLD Clinical, Translational and Outcomes Award from the AASLD Foundation (AMM). This research was supported, in part, by a grant from the NIH T32 DK 007634 (to GVL). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Figures

**Figure 1.**
Treatment decision determinants for patient and provider participants. *Source.* Listed based on the frequency that attributes were mentioned in qualitative interviews.

See this image and copyright information in PMC

References

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Exploring the Role of Patient Preferences in Hepatocellular Carcinoma Treatment Decisions: A Qualitative Study

Affiliations

Exploring the Role of Patient Preferences in Hepatocellular Carcinoma Treatment Decisions: A Qualitative Study

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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