A nurse-led FibroScan® outreach clinic encourages socially deprived heavy drinkers to engage with liver services

J Clin Nurs. 2019 Feb;28(3-4):650-662. doi: 10.1111/jocn.14660. Epub 2018 Sep 24.


Aims and objectives: To determine whether a portable FibroScan® device can be an acceptable screening tool for chronic liver disease in a community alcohol support service, through recording uptake, determining apparent prevalence of undiagnosed fibrosis/cirrhosis in participants and report engagement following referral to specialist liver services of those individuals referred because of a FibroScan® reading ≥ 7.1 kilopascals (kPa).

Background: Alcohol-related liver disease, including cirrhosis, is a major cause of death in the UK. Liver disease is silent and usually presents late. Socially deprived patients with alcohol-related liver disease are a "hard to engage" population and at higher risk of death than less deprived. A FibroScan® device is a non-invasive tool for measuring liver stiffness. A result of ≥7.1 kPa can indicate possible chronic liver disease.

Design: Prospective observational study.

Method: Individuals who self-identified as harmful drinkers were recruited. Consented individuals attended for a liver FibroScan® . Those with a reading ≥7.1 kPa were referred to a nurse-led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for compliance over a 6-month period.

Results: Seventy-nine consented individuals participated, an uptake of 67% of those informed of the study. Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® ≥7.1 kPa requiring referral on to the nurse-led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n = 12) was ≥90%.

Conclusion: A nurse-led FibroScan® outreach clinic encourages socially deprived drinkers to engage with liver services.

Relevance to clinical practice: A 67% uptake suggests a nurse-led FibroScan® service in a community alcohol service is acceptable. High engagement gives potential for early intervention and improved health outcomes.

Keywords: FibroScan®; alcoholic; liver cirrhosis; nursing assessment; screening; transient elastography.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Alcoholism / complications
  • Alcoholism / nursing*
  • Community Health Services
  • Elasticity Imaging Techniques
  • Female
  • Humans
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / etiology
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • United Kingdom