Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease
Document Type
Article
Publication Date
3-1-2024
Abstract
Background & Aims: Patients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers. Methods: Members of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey. Results: Surveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was ``fatty liver'' (88% at least sometimes); ``metabolic disease'' or ``MAFLD'' were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between ``NAFLD'', ``fatty liver disease (FLD)'', ``NASH'', or ``MAFLD''. The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with ``FLD'' among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term ``fatty'' was stigmatizing, while 34% believed that ``nonalcoholic'' was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting ``steatotic liver disease'' as stigmatizing was low (14%). Conclusions: The perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties. (c) 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Keywords
fatty liver, discrimination, patient-reported outcomes, communication, metabolic, MASLD, MASH, SLD
Divisions
ummc
Funders
Center for Outcomes Research in Liver Diseases (COR-LD)
Publication Title
Journal of Hepatology
Volume
80
Issue
3
Publisher
Elsevier
Publisher Location
RADARWEG 29, 1043 NX AMSTERDAM, NETHERLANDS