Improving Melanoma Patient Knowledge and Follow-Up Adherence at a Southwest Urban Dermatology Clinic

Abstract

Background: Melanoma is the most dangerous type of skin cancer and especially prevalent in the southwest urban city of Phoenix, Arizona. There is a need for improving melanoma patient education about the melanoma diagnosis and evidence-based follow up recommendations. Following evidence-based recommendations for following up with a provider is the most effective way to identify and treat any possible new melanoma lesions or recurrences. Purpose: The purpose of this quality improvement project was to facilitate patient education and to improve patient knowledge regarding melanoma, including follow-up recommendations, to determine preferences for follow-up reminders, and to assess patient satisfaction with this educational intervention. Methods: A pre-test/post-test comparison study was performed over a three-week period at a local dermatology clinic, Camelback Dermatology and Skin Surgery. Convenience sampling of patients in this clinic that had a melanoma diagnosis within the past three years produced a sample of 27 participants. The intervention consisted of a pre-appointment survey. Upon completion, they were given a one-page, double-sided pamphlet that provided evidence-based information about melanoma, follow up recommendations, how to protect yourself from the sun, and how to perform a self-skin exam. After the patient saw the provider, they were given the post-appointment survey, which tested change in knowledge, satisfaction with the education, and assessed preference for follow up reminder methods. Data from these surveys were analyzed using descriptive statistics and summarization of free-text responses. Results: There were 27 patients who participated in the study, all of which fully completed all pre- and post-tests. The sample was 56% female and the average age was 59 years old. The most common time frame of most recent melanoma diagnosis was a diagnosis in the past 1-2 years. Knowledge scores improved from an average 4.70 points out of 7 on the pre-test to an average 6.48 points out of 7 on the post-test. A paired t-test showed that the improvement in knowledge from pre-test to post test was both statistically and clinically significant. Patient satisfaction with the education was on average scored higher than a ‘4,’ or somewhat agree, out of a possible ‘5.’ For follow up reminder methods, patients preferred text message most, with a telephone call second, and a mailed post card last. Conclusion: At this southwest urban dermatology clinic, patients were given an educational pamphlet and a pre-test and post-test showing a statistical and clinical significant improvement in melanoma patient knowledge. This educational tool was well received and found to improve patient knowledge and will be provided routinely in all new melanoma patient visits. This clinic should consider changing their reminder method to text messages and track appointment attendance rates.