P116 The effectiveness of an enhanced peer support and patient navigation pathway on increasing HCC surveillance attendance: a service evaluation of the HELIXR programme

<h3>Background</h3> Patients with cirrhosis have an increased risk of hepatocellular carcinoma, and guidelines recommend 6-monthly ultrasound surveillance. Uptake is poor, particularly in under-served populations. The HELIXR pilot utilises patient navigation and if needed, peer support workers, to improve attendance and address health inequalities. The aim of this evaluation was to assess the impact of HELIXR on surveillance attendance. <h3>Methods</h3> Patients eligible for surveillance who had missed an appointment or had been referred by a clinician due to non-attendance were entered into HELIXR. Data were extracted from hospital records and navigator/peer reported information and analysed using SPSS. The primary outcome – surveillance attendance within 6 months of enrolment – was analysed using binary logistic regression models, both unadjusted and adjusted for demographic covariates. Chi-squared tests were performed to compare sociodemographic groups. <h3>Results</h3> Of the cohort (N=483), N=325 (67%) were male and N=420 (87%) were of White British ethnicity. N=113 (23%) had postcodes from the most deprived IMD quintile. The most common aetiology of cirrhosis was alcohol-related liver disease (N=160: 33%). 63 were removed due to declining or ineligibility for surveillance. Of the 420 eligible for analysis, N=330 (78.6%) attended surveillance within 6 months; this compared to 47% of appointments being attended in the cohort prior to HELIXR. N=303 (72%) were allocated to navigator support only, with 104 (25%) referred to receive additional peer support. A significantly higher number receiving peer support were from the most deprived IMD quintile (34.6% vs. 17.2%, p&lt;0.001). Patients successfully contacted by a navigator had an unadjusted odds ratio of surveillance attendance of 4.0 (p&lt;0.001, 95% CI 2.02–7.82) compared to patients in the cohort where contact was not successfully made. Adjusting for covariates, the odds ratio increased to 5.1 (p&lt;0.001, 95% CI 2.27–11.37). Patients who engaged with a peer support worker had an adjusted odds ratio of surveillance attendance of 3.8, (p=0.01, 95% CI 1.37–10.72) compared to those in the cohort who had not engaged or been referred to peers, although the unadjusted model was not significant. <h3>Discussion</h3> A two-tier, enhanced care programme to support disengaged and marginalised patients to engage with HCC surveillance increased attendance. Patients living in more deprived areas were more likely to need patient navigation and a peer to support attendance, highlighting the additional benefit of peers in engaging our most marginalised patients. A controlled trial with cost-effectiveness evaluation is needed to investigate whether the benefits of the programme offset the additional costs.