Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study

Abstract

Background Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty‐six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. Methods Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two‐round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. Results Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. Conclusion This study provides a multi‐stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).

Measuring the quality of skin cancer management in primary care: A scoping review

“…High-risk surveillance 69,73 Using the preventive effects of ultraviolet (UV) radiation protection and vitamin B6 on AK progression 69 Information on the hazards of occupational UV radiation and behaviour change recommendations for workers with occupational exposure to UV radiation 73 Diagnostic process Unassisted visual diagnosis 17,66,[68][69][70][71]75,76 Proportion of correct diagnoses of melanoma by physician (compared to dermatologist diagnosis as gold standard) 75 29 (63) Sensitivity and specificity for melanoma detection by dermatologists and GPs during clinical skin cancer screening 68 Diagnostic-tool assisted diagnosis 17,[59][60][61][62][63][64]69,70,77,78 Proportion of melanomas that were found with the aid of totalbody photography or sequential digital dermoscopy imaging 78 Odds ratio of correctly diagnosed lesions with a dermoscope versus without a dermoscope 62 Diagnostic biopsy performance 17,23,34,46,62,69,71,75,76,[79][80][81][82][83][84]…”

“…Pathology delays 71,81,88 Time interval (delays) from primary excision until registration of histopathological diagnosis in patients with melanoma 81 Referral delays 81,88 Referral lead time between primary care and university level care 88 Treatment delays 71,81,[88][89][90][91] Surgical delay of 1.5 months from biopsy to excision in patients with melanoma 89 Treatment process Excision performance and adequacy 17,23,25,28,34,37,46,62,66,68,69,[71][72][73]76,[78][79][80][81][82][83]85,87,88,[91][92][93][94] Proportion of excisions performed on skin lesions suspected of malignancy 17…”

“…Rate of incomplete excisions of non-melanoma skin lesions 92 Other surgical treatment 46,66,69,71,73,87 Proportion of squamous cell carcinomas treated by curettage 87 Completion lymph node dissection should not be performed following a positive sentinel lymph node biopsy 46 Non-surgical treatment 17,34,67,69,72,73,79,92 Proportion of non-melanoma skin lesions treated using cryotherapy 92 Proportion of melanomas treated with imiquimod 79 Post-treatment follow-up 34,67,70,72,73,78,81,88,95 Proportion of melanoma patients requiring follow up after initial excision in primary care 81 Use of patient recall systems for each skin cancer type 95 Interpersonal process…”

“…effects of care on health status), with good structure and process contributing to better outcomes. 44,45 A set of quality indicators for the diagnosis and management of early stage cutaneous melanoma was recently developed, 46 targeting readily available measures of care processes such as pathology results. 46 It is also important to address the influence of setting (i.e.…”

Association of Sentinel Node Biopsy and Pathological Report Completeness with Survival Benefit for Cutaneous Melanoma and Factors Influencing Their Different Uses in European Populations

“…The quality and completeness of pathology reports (PR), with full descriptions of key parameters, is considered an indicator of standard care [ 1 , 2 , 3 , 4 ], as it is important to accurately profile and stage patients, guiding the selection of appropriate treatment and consequently improving the quality of care and outcomes. Despite recent updates in guidelines [ 5 , 6 ], the features currently considered of primary importance in melanoma care and outcomes largely correspond to those used in 2009–2013.…”