What Hepatology Clinicians and Their Patients Think of Wearable Alcohol Biosensors to Aid Clinical Care for Alcohol Related Liver Disease: A Qualitative Study

Background/Significance:

Early alcohol use identification can reduce morbidity/mortality for alcohol-associated liver disease (ALD). Alcohol biosensor monitors (ABM) are electrochemical devices that measure alcohol vapor secreted in perspiration and by inference, alcohol consumption (Marques, 2007). ABMs could facilitate monitoring of alcohol abstinence providing both ALD patients and clinicians critical information for developing and adjusting treatment plans. A recent review of ABMs found of 22 published studies only 4 included participants with alcohol use disorder and 8 focused on issues of acceptability and feasibility (Brobbin, 2022). Our aim was to determine ABM perspectives and preferences for ALD patients and their clinicians.

Methods:

This study was approved by the University of Pittsburgh Human Research Protections Office. All participants signed informed consent prior to participation.

ALD patients and hepatology clinicians participated in a qualitative interview conducted by a trained research interviewer using a semi-structured script of open-ended questions with prompts to explore participants’ perceptions of ABM use. Eligible patients had a recent hospitalization for decompensated ALD, intended to stop drinking, and were followed at our liver specialty clinic. Patients were interviewed after 3 months of ABM wear. Clinician participants’ qualitative interviews included showing them the ABM device and providing copies of visual data created from ABM wear. Interviews were organized around seven categories: usability, acceptability, feasibility, efficiency/effectiveness, impact of device on behavior/clinical practice, preferences or barriers and utility. Interviews were audiotaped, transcribed, and coded using a constant comparison method. Coding discrepancies were resolved by consensus.

Results:

Patients (n=23) were 56% female, 44+10 years old, and 87% white. Most had moderately severe liver disease. Most of the negative comments involved useability (device was cumbersome and uncomfortable) and acceptability (appearance was conspicuous). Many felt it was feasible to use. Patients felt the device could more effectively track their alcohol use than self-report due to their forgetting or minimizing use. Importantly they felt wearing the ABM motivated abstinence, gave accountability, and provided sense of security.

Clinicians (n=13) were mostly hepatologists (77%), 46% female, practicing 15+11 years and seeing an average of nearly 40 ALD patients/month. Clinicians felt ABM data could critically inform clinical decision making especially identifying patterns and timing of use. However, concerns were raised about the volume and complexity of data, and the time needed to analyze and utilize it in practice.

Discussion:

Both groups felt ABMs could be helpful if specific concerns could be mitigated. Patients would appreciate a more comfortable and less obtrusive device. Clinicians would appreciate more user-friendly data.

Conclusion/Implications:

Patient and clinician perspectives indicate ABMs could benefit patient-clinician encounters as well as providing therapeutic value to patients. However, improving the appearance and comfort of ABM devices is critical to clinical deployment, and simplifying the data would improve clinician utilization.

References:
Brobbin E, Deluca P, Hemrage S, Drummond C. Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review. JMIR Hum Factors. 2022 Dec 23;9(4):e40210. doi: 10.2196/40210. PMID: 36563030; PMCID: PMC9823584.

Marques PR, McKnight AS. Evaluating transdermal alcohol measuring devices. Washington, DC, National Highway Traffic Safety Administration; 2007. (DOT HS 810 875)