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Differences in cutaneous melanoma treatment and patient satisfaction.

ABSTRACT: Although clinical guidelines exist, the management of patients with cutaneous melanoma (CM) is a complex process that may vary between different care providers with potential dysfunctions ultimately mirrored in the overall patient satisfaction. The aim of the present study was to investigate the CM management as related to lead times, surgical quality and diagnosis communication with the hypothesis that the care may differ between providers and disparities may impact patient satisfaction. Medical records of 181 patients were retrospectively analyzed with parallel patient satisfaction evaluation by telephone interviews. Overall mean lead times from initial diagnosis until completion of all surgery and histopathology reports were 80-100 days and delays occurred at every step of the process. General practitioners performed excision biopsies faster however this was mitigated by slower histopathology processing. University level CM care showed less lag time between excision biopsy, wide local excision for thick melanomas and histopathology confirmation. University level care operated with twice the surgical margin as compared to general practitioners and non-university level specialists. Male patients had larger excision biopsy margins and significantly shorter lead times than female patients. Patient satisfaction rates were generally higher in the academic hospitals as compared to general practitioners and non-university dermatology clinics. Surprisingly, there was no correlation between lead times and patient satisfaction. Taken together, CM show substantial variation and caution should be practiced when using patient satisfaction as a quality indicator.

SUBMITTER: Wikstrom JD

PROVIDER: S-EPMC6201885 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Differences in cutaneous melanoma treatment and patient satisfaction.

Wikstrom Jakob D JD Lundeberg Lena L Frohm-Nilsson Margareta M Girnita Ada A

PloS one 20181025 10

Although clinical guidelines exist, the management of patients with cutaneous melanoma (CM) is a complex process that may vary between different care providers with potential dysfunctions ultimately mirrored in the overall patient satisfaction. The aim of the present study was to investigate the CM management as related to lead times, surgical quality and diagnosis communication with the hypothesis that the care may differ between providers and disparities may impact patient satisfaction. Medica ...[more]

PMID: 30359387

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Project description:Purpose:This study aims to increase the knowledge about the characteristics of cutaneous melanoma in Argentina, their association with the risk of having Breslow ?1 mm and mortality trends for the period 2002-2017. Patients and methods:Descriptive statistics and regression analyses were done for 10.199 cases within the Argentine Melanoma Registry in the period 2002-2018. Trends in age-standardised mortality rates (ASMR) were analysed using the Join point Regression Model. Results:Cases showed lesions mainly located in males' trunk (37%) and in females' lower limbs (29%). The level of invasion was higher in males who also showed higher mortality. Cases from the North West and North East regions showed a major risk of Breslow >1 mm and harboured CM in lower limbs more frequently than in other regions. Nearly, 25% of tumours over 2 mm were in cases aged <50 years and 37.6% in patients ?50 years. In the North West, North East and Patagonia, the frequency of cases in young people was higher than in older people. In 43% of cases, the melanoma subtype was not specified in the report. The number of superficial spreading melanomas, the most common histology, was nearly twice that of Nodular melanomas the following histology in importance (3,403 and 1,754, respectively). Melanoma mortality rates in all Argentine population increased in the elderly. Lower melanoma mortality rates were observed in the North West. In 2007-2017, ASMR decreased significantly in females (average 1.4% p/year) while it increased nonsignificantly in males (0.4% p/year).The tumours with the worst prognosis were associated with the elderly, males, nodular or acrolentiginous morphologies, residing somewhere other than Centro and Patagonia and with tumors located in the head/neck and legs. Conclusion:The geographical variations found for melanoma characteristics and their mortality in Argentina, makes it imperative that epidemiological research is continued to avoid generalisations and improve future preventive actions.

Project description:There are no universally accepted guidelines for the follow-up of individuals with cutaneous melanoma. Furthermore, to date, there have been no randomised controlled trials of different models of melanoma follow-up care. This randomised controlled trial was conducted to evaluate the effects of GP-led melanoma follow-up on patient satisfaction, follow-up guideline compliance, anxiety and depression, as well as health status.A randomised controlled trial of GP-led follow-up of cutaneous melanoma was conducted over a period of 1 year with assessment by self-completed questionnaires and review of general practice-held medical records at baseline and 12 months later. It took place in 35 general practices in North-east Scotland. Subjects were 142 individuals (51.4% women 48.6% men; mean (s.d.) age 59.2 (15.2) years previously treated for cutaneous melanoma and free of recurrent disease. The intervention consisted of protocol-driven melanoma reviews in primary care, conducted by trained GPs and supported by centralised recall, rapid access pathway to secondary care and a patient information booklet. The main outcome measure was patient satisfaction measured by questionnaire. Secondary outcomes were adherence to guidelines, health status measured by Short Form-36 and the Hospital Anxiety and Depression Scale.There were significant improvements in 5 out of 15 aspects of patient satisfaction during the study year in those receiving GP-led melanoma follow-up (all P<or=0.01). The intervention group was significantly more satisfied with 7 out of 15 aspects of care at follow-up after adjustment for potential confounders. There was significantly greater adherence to guidelines in the intervention group during the study year. There was no significant difference in health status or anxiety and depression between intervention and control groups at either baseline or outcome.GP-led follow-up is feasible, engenders greater satisfaction in those patients who receive it, permits closer adherence to guidelines and does not result in adverse effects on health status or anxiety and depression when compared with traditional hospital-based follow-up for melanoma.

Dataset Information

Differences in cutaneous melanoma treatment and patient satisfaction.

Publications

Differences in cutaneous melanoma treatment and patient satisfaction.

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