Monitoring quality of care in hepatocellular carcinoma: A modified Delphi consensus

Ashika D. Maharaj, John Lubel, Eileen Lam, Paul J. Clark, Oliver Duncan, Jacob George, Gary P. Jeffrey, Lara Lipton, Howard Liu, Geoffrey McCaughan, Eu Ling Neo, Jennifer Philip, Simone I. Strasser, Katherine Stuart, Alexander Thompson, Jonathan Tibballs, Thomas Tu, Michael C. Wallace, Alan Wigg, Marnie WoodAmany Zekry, Elysia Greenhill, Liane J. Ioannou, Golo Ahlenstiel, Kaye Bowers, Stephen J. Clarke, Anouk Dev, Michael Fink, Mark Goodwin, Christos S. Karapetis, Miriam T. Levy, Kate Muller, James O'Beirne, David Pryor, James Seow, Nicholas Shackel, Caroline Tallis, Nick Butler, John K. Olynyk, Kate Reed-Cox, John R. Zalcberg, Stuart K. Roberts

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Although there are several established international guidelines on the management of hepatocellular carcinoma (HCC), there is limited information detailing specific indicators of good quality care. The aim of this study was to develop a core set of quality indicators (QIs) to underpin the management of HCC. We undertook a modified, two-round, Delphi consensus study comprising a working group and experts involved in the management of HCC as well as consumer representatives. QIs were derived from an extensive review of the literature. The role of the participants was to identify the most important and measurable QIs for inclusion in an HCC clinical quality registry. From an initial 94 QIs, 40 were proposed to the participants. Of these, 23 QIs ultimately met the inclusion criteria and were included in the final set. This included (a) nine related to the initial diagnosis and staging, including timing to diagnosis, required baseline clinical and laboratory assessments, prior surveillance for HCC, diagnostic imaging and pathology, tumor staging, and multidisciplinary care; (b) thirteen related to treatment and management, including role of antiviral therapy, timing to treatment, localized ablation and locoregional therapy, surgery, transplantation, systemic therapy, method of response assessment, and supportive care; and (c) one outcome assessment related to surgical mortality. Conclusion: We identified a core set of nationally agreed measurable QIs for the diagnosis, staging, and management of HCC. The adherence to these best practice QIs may lead to system-level improvement in quality of care and, ultimately, improvement in patient outcomes, including survival.

Original languageEnglish
Pages (from-to)3260-3271
Number of pages12
JournalHepatology Communications
Issue number11
Early online date25 Sept 2022
Publication statusPublished - Nov 2022


  • hepatocellular carcinoma (HCC)
  • management
  • quality of care
  • patient outcomes
  • Delphi consensus study


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