Purpose: Liver cancer is fifth leading cancer and the second leading cause of death from cancer worldwide. Comprehensive liver cancer control plans may help reduce the burden of liver cancer, but implementation will require high stakeholder motivation. The purpose of this study was to identify predictors of motivation to implement comprehensive liver cancer control among stakeholders in 12 countries.
Method: Liver cancer stakeholders were purposively selected and completed an interviewer-assisted survey on liver cancer policy, including a measure of motivation to implement comprehensive liver cancer control using a valence-instrumentality-expectancy (VIE) approach. Respondents rated whether they could affect liver cancer plans (expectancy), whether the plans would have an impact (instrumentality), and whether such impacts were valuable (valence). Valence, instrumentality, and expectancy ratings were multiplied to get a score between 1 and 245. Individual level data on respondents’ roles were collected in the survey. Country level data on liver cancer outcomes and country resources were extracted from the GLOBOCAN, Global Health Observatory Data Repository, and the United Nations Statistics Division’s Social Indicators datasets. Predictors of motivation were assessed using individual, country, and mixed effects multilevel models.
Result: 579 potential respondents were identified and 240 respondents from Australia, China, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, Thailand, Turkey, and USA completed the survey (completion rate: 42%). Italian (p=0.001) and German (p=0.009) stakeholders had lower motivation than Americans, and stakeholders working at an international (p=0.013) or regional/provincial (p=0.024) level had higher motivation than those working at a local/municipality level. At the country level, GDP per capita predicted lower motivation (p=0.037) and liver cancer as a proportion of all cancer deaths predicted higher motivation (p=0.013). In the multilevel model, liver cancer as a proportion of all cancer deaths (p=0.004) GDP per capita (p=0.009) remained significant.
Conclusion: Stakeholders from countries where liver cancer is responsible for a higher proportion of cancer deaths are more motivated to implement comprehensive plans, suggesting motivation may be influenced by prioritization based on epidemiological needs. Motivation is higher among stakeholders from lower GDP per capita countries, suggesting potential to improve liver cancer control even in lower-resource countries. These findings suggest that WHO recommendations for less comprehensive cancer control plans in lower-resource countries may be inappropriate given the importance of liver cancer in those same countries.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making