Patient satisfaction with GP-led melanoma follow-up: a randomised controlled trial

Abstract

BACKGROUND: 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. METHODS: 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 protocoldriven 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. RESULTS: 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 Pp0.01). 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. CONCLUSIONS: 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.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…In the first years after the diagnosis of melanoma, patients at low risk for recurrence predominantly require reassurance that no recurrence is present [606,607]. In the study by Murchie et al, this goal was achieved by general practitioners offering phone consultations, thus avoiding frequent follow-up exams.…”

Optimal follow-up for melanoma

“…Recently, randomized controlled trial evidence was published that supports these statements. The authors concluded that GP-led follow-up is feasible and does not result in adverse effects on patients' health status or quality of life [64]. Another British study, however, concluded that GP-led follow-up for melanoma can be appropriate for only a small subgroup of patients.…”

“…Consequently, the University Medical Center Groningen has recently started a melanoma clinic in which dedicated nurse practitioners participate in the routine follow-up of melanoma patients and clinical trials to reduce the workload of specialists and improve patient satisfaction. Additionally, following the results of the trial by Murchie [64], part of melanoma care may possibly be transferred to GPs.…”

Redefining Dermatologists’ Role in Skin Cancer Early Detection and Follow-up Care

“…Strategies for minimizing this burden have been explored in recent years, with researchers and clinicians investigating alternative models of care and the integration of self-examination into skin cancer monitoring. For example, moving follow-up from specialized melanoma clinics to family physicians has been tested in trials in the United Kingdom, 7 and studies have begun investigating the role of mobile consumer teledermoscopy. Most guidelines for melanoma prevention and follow-up recommend that people conduct regular skin self-examinations.…”