DS08: Exploring unmet needs and attitudes to skin self‐examination in melanoma survivors: interim results

Abstract

Evaluation of telephone consultations prior to Mohs surgery: the importance of informed consent A. Brown and E.J. McGrath Royal Devon and Exeter NHS Foundation Trust, Exeter, UK The updated General Medical Council (GMC) guidance on consent (2020) states that ‘decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient’. In the UK there are several barriers to this process in dermatology, including short clinic appointments and loss of continuity of care (the surgeon may not have seen the patient in clinic). Many barriers have been exacerbated by the COVID-19 pandemic with the additional challenges of telephone consultations. In light of the GMC guidance we conducted a survey to see what patients recalled of their clinic discussion prior to surgery. Seventy-six responses were received over 2 weeks from patients attending day surgery. The results showed that although the majority of patients received an information sheet on skin surgery there were significant inconsistencies in what was discussed in clinic with regard to alternative options, risks and benefits of surgery and the likely repair. We addressed the problem of inadequate preparation for complex surgery by implementing a new process for patients awaiting Mohs surgery. A senior registrar on the Mohs team contacted patients by telephone 2–3 days before surgery. During the telephone call the process of Mohs surgery, the risks and benefits (including the risk of attending the department during the COVID-19 pandemic), and alternative options to Mohs were discussed. The repair options were discussed in detail. Patients were also advised on transport, provision of victuals, postoperative wound care and the potential necessity of future appointments. The telephone calls lasted 5–12 min (average 6 min 48 s). When patients attended for surgery they were asked to complete a patient survey to evaluate their telephone consultation. Seventeen responses were received from the second survey over 2 weeks. Fifteen patients recalled alternative options to Mohs surgery being discussed prior to attending surgery and 15 recalled the risks of surgery being discussed. All patients recalled discussing the potential options for repair, and all patients felt that they had received adequate information prior to attending their surgical appointment. On a scale of 1–5 (1 being very uncertain and 5 being very confident) patients were asked to rate their confidence in the procedure after their telephone call with the surgeon. The majority rated 5 (n = 13), three scored 4 and one scored 2. Shared decisionmaking and fully informed consent is critical to effective patient care. It is particularly important prior to complex skin surgery such as Mohs, and patients should have the opportunity to discuss their procedure with a Mohs specialist before surgery. We demonstrated that a telephone call before surgery is an effective and time-efficient method that ensures patients are fully informed and increases their confidence in the procedure. DS08 Exploring unmet needs and attitudes to skin selfexamination in melanoma survivors: interim results R. Bali, S. Khan, C. Nwolise, A.J. Xu, R. Doohan, C.M. Proby, C. Jenkinson, F.M. Walter and R.N. Matin Oxford University Hospitals NHS Foundation Trust, Oxford, UK; University of Oxford, Oxford, UK; Ninewells Hospital and Medical School, Dundee, UK; and University of Cambridge, Cambridge, UK Addressing the unmet psychological needs of melanoma survivors is a challenge. There is little evidence in the UK reporting the baseline needs of survivors of melanoma to understand how best to support people living with and beyond their melanoma diagnosis. Exploring Unmet Needs and Attitudes to Skin Self-examination in melanoma survivors (EUNASS) is a prospective multicentre cohort study aimed at assessing the quality of life of survivors of melanoma and their attitudes towards skin self-examination (SSE). Participants aged ≥ 18 years, diagnosed with American Joint Cancer Committee (AJCC V8) stage I–III primary cutaneous melanoma in the last 3–12 months, were invited to self-complete an electronic questionnaire. The EUNASS study questionnaire (using Qualtrics software) assessed fear of recurrence, sun protection behaviour, SSE habits and sociodemographic details. Interim data were analysed using Microsoft Excel. The response rate was 35 of 80 in the first 4 months of data collection. Overall, 33 of 35 participants fully completed the EUNASS questionnaire. The mean time from melanoma diagnosis to participation was 10 months, with 37% of primary melanomas affecting the head/neck. At the most recent consultation (40% seen by a plastic surgeon and 29% seen by medical oncologist), 71% discussed surgical wound healing, 29% were given sun-protection advice, 29% discussed recurrence risk and emotional/psychological wellbeing was explored in 26%. Regarding the fear of recurrence, 85% expressed some anxiety about recurrence (two of 35 reported substantial anxiety) and 86% regularly thought about recurrence, with 66% spending a few seconds/minutes on this every day. Regarding sun protection, 23 of 34 respondents practised sun protection in the past year, and 24 of 34 were extremely likely to practise it in the coming year. Regarding SSE practices 37% discussed SSE at their last consultation, 57% reported performing SSE at least monthly, 11% performed it every 6 months and one individual never practised SSE. SSE was reported to be helpful in 80%, 44% lacked confidence in recognizing skin cancers and 83% were more likely to perform SSE if a doctor emphasized its importance. Fifty-one per cent preferred to have a doctor examine their skin rather than perform their own SSE. In summary, the interim data show wide variability in the issues discussed with patients during surveillance consultations and demonstrate significant anxiety among survivors of melanoma regarding their risk of recurrence. SSE practices are inconsistent and clinicians have an important role in educating patients to increase uptake. In a resource-constrained healthcare system, strategies to encourage self-management are essential. Further evaluation of a larger cohort combined with