Optimising liver cyst management: a digital educational intervention study

Abstract Background Benign liver cysts are frequently encountered incidental findings and are commonly managed conservatively without follow-up. However, poor adherence to guideline-based management may result in unnecessary imaging, referrals, and healthcare costs. Educational interventions may improve clinical decision-making, but evidence of real-world impact remains limited. This study evaluated a guideline-based e-learning module on clinicians’ knowledge, attitudes, behaviours, and clinical outcomes in liver cyst management. Methods A quasi-experimental study was conducted at the University of Malaya Medical Centre involving 54 clinicians from surgical, gastroenterology, and primary care departments. Knowledge, attitude, and behaviour were assessed at baseline, immediately post-intervention, and at one and three months. Technology acceptance was evaluated using the Technology Acceptance Model (TAM). Real-world clinical outcomes were compared over three months before and after implementation, including imaging utilization, clinic referrals, guideline adherence, waiting times, and estimated costs. Non-parametric statistical analyses were performed because of non-normal data distribution. Results Knowledge scores improved significantly across the four assessment points (Friedman χ²=76.66, df = 3, p < 0.001), as did attitude scores (χ²=21.00, df = 3, p = 0.001), with improvements maintained at three months. Behavioural assessment demonstrated sustained guideline-consistent decision-making. Following implementation, total imaging requests decreased from 119 to 48, including reductions in ultrasound, CT, and MRI utilization. Estimated imaging and follow-up costs decreased from RM33,910 to RM11,425. Guideline adherence increased from 41.1% to 65.4%. Follow-up imaging requests decreased, with more patients discharged without further investigation. TAM measures remained favourable, indicating sustained clinician acceptance of the intervention. Conclusions A guideline-based e-learning intervention was associated with sustained improvements in clinician knowledge, attitudes, and guideline-consistent behaviour, alongside reduced imaging utilization and healthcare expenditure. These findings support digital education as a scalable approach to improving guideline adherence and resource stewardship in hepatobiliary practice.