P19 High patient acceptability of fibrosis assessment embedded within the type 2 diabetes annual review: a qualitative process evaluation of the PRELUDE 1 study

<h3>Introduction</h3> Early-detection pathways for metabolic-disfunction associated liver disease (MASLD) aim to identify patients likely to have advanced fibrosis (≥F3) for referral to secondary care. There are limited data on the experience of patients and healthcare professionals (HCPs) using the same pathway; an important factor in assessing acceptability of implementation. We performed a qualitative process evaluation nested within the PRELUDE 1 study,¹ exploring experiences of patients and HCPs using an early-detection pathway embedded in the Type 2 Diabetes (T2DM) annual review. <h3>Methods</h3> We undertook semi-structured interviews and focus groups for patients living with T2DM who accepted assessment for MASLD embedded in their annual review and the GPs and diabetic specialist nurses (DSN) delivering this in primary care. This involved a 2-tier assessment with Fibrosis-4 (FIB-4) and if ≥1.3, vibration-controlled transient elastography (VCTE) (figure 1). Interviews and focus groups were recorded and transcribed anonymously. Qualitative methodology using thematic analysis with a theoretical framework based on Candidacy² was performed. <h3>Results</h3> 20 patients (mean age 66, 60% male) were interviewed. 11 HCPs (3 GPs, 8 DSNs) took part in interviews and focus groups. We identified three themes of prior knowledge, acceptability of testing and ongoing risk-factor optimisation. Patients and HCPs had limited knowledge of the link between diabetes control and fibrosis risk. Despite this, patient acceptability was high with reasons centering around outsourcing of decision making to HCPs and boosting of individual critical health literacy with testing. For both groups, results of fibrosis assessment were poorly understood. Whilst a low risk FIB4 or liver stiffness was reassuring, if not explained with appropriate sign-posting and information this led to minimisation of future risk with potential negative effects on future lifestyle interventions. <h3>Conclusions</h3> The link between diabetes and fibrosis is poorly understood by patients and HCPs. Acceptability of an early-detection pathway in the T2DM annual review is high. Careful communication of a low risk fibrosis result to patients in primary care is key to ensure there is no minimisation of future risk. <h3>References</h3> Brindley JH, K Abeysekera, G Hood, <i>et al.</i> Feasibility and acceptability of a primary care liver fibrosis testing pathway centred on the diabetes annual review: PRELUDE1 prospective cohort study protocol. <i>BMJ Open</i>, 2023;<b>13</b>(5):e066493. Dixon-Woods M, D Cavers, S Agarwal, <i>et al.</i> Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. <i>BMC Medical Research Methodology</i>, 2006;<b>6</b>(1).