Patient Preferences in Hepatocellular Carcinoma Surveillance: A Multisite Conjoint Analysis

INTRODUCTION: Several emerging modalities are available for hepatocellular carcinoma (HCC) surveillance; however, patient preferences for surveillance tests-particularly across key subgroups such as race/ethnicity, income, and education level-are poorly characterized. METHODS: We conducted a choice-based conjoint survey among patients with cirrhosis and chronic hepatitis B undergoing HCC surveillance (from 2022 to 2024) at 7 centers in the United States. Participants were presented with 15 scenarios, where they chose between surveillance modalities based on test attributes. RESULTS: We included 649 patients, with a median age of 60 years, 51% male, 60% White, 10% Black, and 20% Hispanic. The cohort reflected substantial socioeconomic variation including 12% with Medicaid and 38% with Medicare. The highest priority attribute was surveillance benefits (42.9%; 95% confidence interval [CI] 40.6%-45.1%), followed by financial harms (19.4%; 95% CI 18.1%-20.7%). Patients placed less priority on test logistics (12.3%; 95% CI 11.5%-13.2%), test location (9.2%; 95% CI 8.5%-10.0%), test duration (8.3%; 95% CI 7.8%-8.7%), and physical harms (7.9%; 95% CI 7.2%-8.6%). In subgroup analyses, Black participants placed significantly lower importance on surveillance benefits and higher importance on financial harms ( P < 0.001) and test duration ( P = 0.001) compared with White participants. Hispanic participants also prioritized financial harms more than non-Hispanic participants ( P < 0.001), a pattern consistent with cost-related concerns seen across other lower socioeconomic status (SES) subgroups. Lower SES individuals with below a high school education ( P = 0.01), Medicaid insurance ( P = 0.001), and income below $25,000 ( P < 0.001) assigned greater importance to financial harms and less to surveillance benefits. DISCUSSION: Patients with undergoing HCC surveillance prioritize surveillance test sensitivity; however, results vary by race, ethnicity, and SES. Improving access by reducing financial and logistical barriers through shared decision-making may enhance surveillance, particularly when modalities present with similar effectiveness.