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Discordant themes exist in skin cancer assessment outcomes among physicians, patients

Areas of disagreement between patients and physicians on skin cancer-related outcomes include patient fear of the unknown, recurrence and empowering patients to make treatment choices, according to researchers in Dermatologic Surgery.

“The shift from a physician/disease-specific point of view to a patient-oriented one has created a new set of qualitative outcomes,” Anthony M. Rossi, MD, of the dermatology service at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College in New York, and colleagues wrote.

Researchers obtained a list of 53 skin cancer treatment-related themes and outcomes from a group of 21 patients. Twelve masked dermatologic surgeons rated patient-generated skin cancer-related outcomes, and their results were compared with the patient ratings.

The physician and patient panels’ ratings had agreement in 56% of the items, according to researchers. Eighteen items were ranked higher in importance by patients and five items were rated lower in importance by patients compared with physicians.

Outcomes that had a “very high” concordance of greater than 80% agreement between groups included “severity of scar,” “being informed of the treatment options,” “confidence in physician’s ability,” “being heard by my physician,” “ability to return to normal activities” and “open communication with my physician.”

The researchers suggested that agreement in scar severity outcomes shows that both patients and physicians consider the cosmetic long-term results important in skin cancer surgery.

Other outcomes that had a “high” concordance of greater than 70% included “loss of capabilities to do my work (or job required change),” “feeling fully educated about your condition,” “empowered to ask questions” and “feeling respected.”

The items that were the most discordant between physicians and patients offer areas for improvement and highlight existing gaps, according to researchers. They included “fear of unknown future risk of recurrence,” “fear of recurrence of primary cancer,” “proactive outreach from physician’s office,” “feeling empowered to make my own choices for treatment” and “access to reliable information resources, specific to your condition.”

“This patient cohort expressed concerns about future skin cancers and recurrence of the primary tumor, and therefore continuity of care and a plan for future care/preventive care may assuage those concerns,” Rossi and colleagues wrote.

The items in agreement between physicians and patients are broad and cover many levels of patient care whereas the discordant items highlight specific gaps that physicians can address, they concluded.

The researchers encouraged the need for additional resources for patient education. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.