An alternative model of care for liver health care for First Nations patients living in remote communities

The study is divided into three parts: (1) the site engagement phase, (2) the liver check (screening) phase and (3) the liver monitoring (surveillance) phase. In Phase 1 (duration: 12mths, concurrently with Phase 2), the study will focus on engaging with sites about the project, establishing a Community Leadership Group, providing training to the local study team (Principal Investigator and Indigenous Project Officer), and providing community awareness and education. A CLG will be established at each study site and may include local primary healthcare staff, community Elders and local community members, who will be the primary mechanism for community liaison with support from site Principal Investigator (PI) and Indigenous Project Officer (IPO), and project team. The CLG will have up to five members as chosen by the community. The CLG, with the support of the project team, will provide feedback on the project training and resources relevant to their site (including language translation, diagrams and visual representation of service pathways). Training for the local study team will focus on liver disease and the research project and will be provided by two of the study investigators over 2 sessions at 2hrs each within a month of starting Phase 2. Community awareness and education will be an ongoing process, and can vary from one-to-one sessions during a clinic visit to a yarn at the local community centre. This will be determine by each local CLG. In the liver check phase (duration: 12mths, concurrently with Phase 1), members in the community meeting study inclusion criteria will be eligible to have a liver health assessment alongside their routine annual health check. This phase will include simple fibrosis tests that will help identify anyone at potential risk of liver disease complications. This risk will be confirmed by an On-Country scan (using a FibroScan) that will enable diagnosis of advanced liver disease. The liver health check will require one appointment at your local medical health service, and you may need to come in for another appointment for the FibroScan appointment. These appointments will take approximately 20mins each. Participants identified to be at risk of liver cancer in Phase 2 will be invited to take part in Phase 3, the liver monitoring phase (duration: 24mths). This phase of the project will be a stepped-wedge randomised trial to compare two models of liver cancer surveillance — the current model of care and the study On-Country model of care. The new model of care will allow participants to have 6 monthly ultrasounds On-Country (performed by an experienced ultrasonographer) in conjunction with serum biomarker tests for liver cancer. The blood test will take approximately 10-15mins and the liver scan approximately 20mins. Adherence to the intervention will be assessed through collecting information on how many of the 6mthly reviews are attended. Yarning circles will be incorporated at the end of Phase 2 and Phase 3 to explore participant experiences in the study, their knowledge of liver disease and views on the different models of care. Each yarning circle is anticipated to take 1hr.