O13 One-stop hepatic surveillance clinic to improve the care pathway for patients at high-risk of hepatocellular carcinoma (HCC) to encourage adherence

<h3>Background</h3> Liver cancer is the fastest-rising cause of cancer-related deaths in the UK, with hepatocellular carcinoma (HCC) accounting for 85%, with 9 out of 10 cases relating to liver cirrhosis. Early detection through regular surveillance is critical, improving outcome and survival, yet adherence to traditional multi-appointment pathways remains suboptimal. A local service review demonstrated a disseminated requirement for between 6–10 visits to secondary care per year, consequently anecdotal high-rates of non-adherence were found. <h3>Methods</h3> A collaborative one-stop surveillance clinic was established at the James Paget University Hospital (JPUH), operating fortnightly from ultrasound department and department of pathology. The aim to streamline and improve the patient pathway and experience, to allow for improved adherence, reducing the many barriers a patient faces with multiple appointments. The patients within this clinic includes those with liver cirrhosis from a variety of aetiology; Alcohol-Related Liver Disease (ARLD), Metabolic Dysfunction-Associated Steatohepatitis (MASH), Primary Biliary Cholangitis (PBC), Hepatitis C (HCV), as well as Hepatitis B (HBV) with or without cirrhosis. Each patient is offered two annual appointments, tailored to individual needs with services including routine blood monitoring, ultrasound, transient elastography, and specialist nurse review, with collection of regular secondary care medication. <h3>Results</h3> The innovative, multidisciplinary model streamlines previously fragmented surveillance pathways, enhancing patient adherence and reducing appointment no-shows and waiting times. Instant reporting and availability of results enables a productive and interactive clinic appointment, with discussion of results and activation of further pathways, such as HCC management in a timely manner and without delay, with the aim for a better patient outcome with timely treatment to improve mortality. A reduction of appointments resulted in a reduction of visits, time off work and travel expenses for the patients. Also a positive effect on environmental factors, aswell as contributing to the local economy with less working days lost for hospital appointments. While pre-implementation data limitations hindered quantitative evaluation, initial outcomes indicate improved service efficiency and patient experience. <h3>Conclusion</h3> The clinic is now fully incorporated into the service offered at the JPUH with the aim of increasing this to a weekly clinic to offer this to more patients. The one-stop clinic model demonstrates promise in improving liver cancer surveillance and patient outcomes. Future evaluations, incorporating structured data collection at 6 and 12 months, aim to quantify impact and support clinic expansion to weekly sessions. <h3>References</h3> British Liver Trust. (2024). Liver Disease in Numbers – Key Facts and Statistics. British Liver Trust. https://britishlivertrust.org.uk/information-and-support/statistics/ GOV.UK. (2024, April 8). Liver disease profile, April 2024 update. GOV.UK. https://www.gov.uk/government/statistics/liver-disease-profile-april-2024-update/liver-disease-profile-april-2024-update