TY  - JOUR
TI  - Use of non?invasive diagnostic tools for metabolic dysfunction?associated steatohepatitis: A qualitative exploration of challenges and barriers
UR  - https://doi.org/10.1111/liv.15941
PB  - Wiley
SP  - 1990
A1  - Tsochatzis, Emmanuel A
A1  - Valenti, Luca
A1  - Thiele, Maja
A1  - Péloquin, Sophie
A1  - Lazure, Patrice
A1  - Masson, Mounia Heddad
A1  - Allen, Alina M
A1  - Lazarus, Jeffrey V
A1  - Noureddin, Mazen
A1  - Rinella, Mary
A1  - Tacke, Frank
A1  - Murray, Suzanne
KW  - Elastography
KW  -  steatotic liver disease
KW  -  Fibrosis-4 (FIB4) score
KW  -  cirrhosis
KW  -  Enhanced
Liver Fibrosis (ELF) score
KW  -  magnetic resonance imaging (MRI)
IS  - 8
EP  - 2001
SN  - 1478-3223
AV  - public
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
JF  - Liver International
Y1  - 2024/08//
N2  - BACKGROUND AND AIMS:  
Non?invasive tests (NITs) are underutilized for diagnosis and risk stratification in metabolic dysfunction?associated steatotic liver disease (MASLD), despite good accuracy. This study aimed to identify challenges and barriers to the use of NITs in clinical practice.


METHODS: 

We conducted a qualitative exploratory study in Germany, Italy, United Kingdom and United States. Phase 1 participants (primary care physicians, hepatologists, diabetologists, researchers, healthcare administrators, payers and patient advocates; n?=?29) were interviewed. Phase 2 participants (experts in MASLD; n?=?8) took part in a group discussion to validate and expand on Phase 1 findings. Finally, we triangulated perspectives in a hybrid deductive/inductive thematic analysis.


RESULTS: 
Four themes hindering the use of NITs emerged: (1) limited knowledge and awareness; (2) unclear referral pathways for patients affected by liver conditions; (3) uncertainty over the value of NITs in monitoring and managing liver diseases; and (4) challenges justifying system?level reimbursement. Through these themes, participants perceived a stigma associated with liver diseases, and primary care physicians generally lacked awareness, adequate knowledge and skills to use recommended NITs. We identified uncertainties over the results of NITs, specifically to guide lifestyle intervention or to identify patients that should be referred to a specialist. Participants indicated an ongoing need for research and development to improve the prognostic value of NITs and communicating their cost?effectiveness to payers.

CONCLUSIONS: 

This qualitative study suggests that use of NITs for MASLD is limited due to several individual and system?level barriers. Multi?level interventions are likely required to address these barriers.
ID  - discovery10196317
VL  - 44
ER  -