A Conceptual Model for Implementation and Evaluation of Interventions Across the Hepatocellular Carcinoma Care Continuum

Abstract

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide and one of the few cancers with a rising mortality in the United States. There are opportunities for intervention along the cancer care continuum (CCC), which includes risk assessment, primary prevention, detection (ie, screening initiation and follow-up of screening results), diagnosis, and treatment.¹ Each step is prone to failures that are influenced by factors at multiple socioecological levels (ie, patient, provider, health delivery system, community, and policy levels).² We recently described a conceptual model of the steps and interfaces along the CCC that are required for effective implementation of HCC screening in clinical practice.³ Herein, we present a conceptual model for the implementation and evaluation of interventions at each of the socioecological levels using implementation strategies that promote optimal delivery and uptake. We focus on early steps in the CCC, including risk assessment, primary prevention, and early detection (ie, secondary prevention), because these have the greatest potential to reduce HCC mortality.