Introduction: Nonmelanoma skin cancer is the most common type of skin cancer in the United States with over 3.6 million new cases diagnosed annually.1 The majority of these cases are basal cell and squamous cell carcinoma. Mohs surgery may be used to treat nonmelanoma skin cancers on the head, neck and other high risk anatomic areas. In a survey of the American College of Mohs Surgery members, 67% of the respondents reported performing preoperative consultations prior to the day of surgery.2 The benefits of consultation include patient familiarity with the surgeon and vice versa, additional patient time to contemplate treatment options, and better preoperative planning.3 Consultants may be ...view middle of the document...
SMAs appear well suited for Mohs surgery because all patients receive similar information about skin cancer pathophysiology, prognosis, prevention, treatment and reconstructive options. We sought to implement a SMA for the preoperative visit of Mohs surgery and to evaluate patient satisfaction with such a model through a survey. Patient satisfaction is a recognized patient centered outcome, making the acceptance of SMAs important (SOURCE)..
With an increased emphasis on patient centered outcomes such as satisfaction, the acceptance of SMAs is important.
Methods: After reviewing the literature, our SMA was designed. Three unique SMA models have been described: (1) The Drop-In Group medical Appointment focuses on patients with chronic medical conditions grouped by diagnoses. (2) Physicals Shared Medical Appointments are designed for the examination of patients in privacy as part of a routine annual exam or subspecialty care. (3) Cooperative Health Care Clinics combine group education with individual counseling.9, 10 Features of the second and third model were used in our SMA in a combined group and individual visit.
Planning and development: With the approval of the dermatology clinic management , a pilot SMA was initiated based on the input from the Mohs surgeon, medical support staff, scheduling team and clinic management. Schedulers were given information on SMAs and instructed to offer both SMA and regular individual appointments to patients in an unbiased conversation. Schedulers described the structure of the SMA and goals of the visit. All patients had the option of a conventional medical appointment. Only patients with a biopsy proven tumor were eligible for a consultation visit. Patients who had previously had Mohs surgery with the senior author (FS) were not eligible for the SMA. For simplicity the initial SMA series described herein was limited to patients with basal cell carcinoma and squamous cell carcinoma. The complexity of certain skin cancers including melanoma, adnexal neoplasms and Merkel cell carcinoma may be better suited for individual visits.
Structuring the visit: We expected that the optimal clinic flow would result from an SMA education visit followed by individual one-on-one physician examinations. Ninety minutes were allocated for the completion of the SMA. The first part of the visit was spent in a dedicated SMA room with audiovisual equipment. A PowerPoint presentation (Microsoft, Redmond, WA) developed by the senior physician (FS) and the nursing staff was shown to the patients. This presentation covered the etiology, prognosis, risk factors, treatments, and reconstructive options for nonmelanoma skin cancer, wound care, and a description of the day of surgery. Twenty minutes were allocated for this segment of the visit. The educational lecture was followed by time for patients’ questions, although patients were encouraged to ask questions throughout the lecture as well. Prior to completing this visit...