Increasing Knowledge and Awareness of Liver Cancer and Its Risk Factors Among Health Care Providers and Community Coalitions in Cherokee Nation

Introduction: Worldwide, hepatocellular carcinoma (HCC), or primary liver cancer is the second leading cause of cancer death among cancers that affect both men and women, and incidence is increasing in the U.S. HCC disproportionality affects Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native populations compared to other racial and ethnic groups. We present evaluation results of liver cancer prevention interventions implemented within Cherokee Nation from August 2017 through April 2018. Methods: The Cherokee Nation Comprehensive Cancer Control (CCC) Program collaborated with the Infectious Disease (ID) Department within Cherokee Nation Health Services (CNHS) to plan, implement, and evaluate activities to increase knowledge and awareness of HCC among healthcare providers and coalitions. The CCC program was responsible for community outreach, and the ID department was responsible for educating CNHS providers on HCC epidemiology, diagnosis, and surveillance. Three liver cancer prevention interventions (didactic sessions during Extension for Community Health Outcomes (ECHO) meetings, provider education workshops, and community coalition presentations) were implemented. The analysis focused on assessing whether the intervention strategy had any impact on participants’ awareness, knowledge, abilities, and intentions, measured by changes in responses to pre- and post-exposure to survey questions. Descriptive statistics were used to analyze retrospective data. Mean composite scores using Stata (version 14) were used to calculate pre-post intervention using the Likert scale. Results: Didactic sessions during ECHO observed a 3.03 increase (8.23 to 11.26), provider education workshops observed a 4.98 increase (10.63 to 15.61), and community coalition presentations observed a 4.23 increase (6.34 to 10.57) in awareness, knowledge, ability and intention across each of the pre-post interventions. Healthcare providers reported an improved ability to identify patients at risk for viral hepatitis and HCC, as well as an improvement in their intentions to talk to their patients about that risk. Among coalition participants, there was an improvement in ability and intention to talk to their healthcare provider about their risk for liver cancer and about getting tested for viral hepatitis. Conclusion: Our study has implications for the cancer control community, including cancer coalitions and health care providers as they move forward in tackling many of the emerging risks associated with liver cancer. The study serves as an example of the role that provider and community education interventions can have on improving knowledge and awareness of liver cancer and its risk factors among health care providers and community coalitions.