Does biopsy accurately assess basal cell carcinoma (BCC) subtype?

Dermatology-oncolog

AAM Factors influencing current low-value follow-up care after basal cell carcinoma and suggested strategies for de-adoption: a qualitative study.

Providing follow-up to low-risk basal cell carcinoma (BCC) patients can be considered as low-value care. However, dermatologists still provide substantial follow-up care to this patient group, for reasons not well understood. The aim of this study was to identify factors influencing current BCC follow-up practices among dermatologists and suggested strategies to de-adopt this low-value care. In addition, views of patients regarding follow-up care were explored. A qualitative study was conducted consisting of 18 semi-structured interviews with dermatologists and three focus groups with a total of 17 low-risk BCC-patients who had received dermatological care. The interviews focused on current follow-up practices, influencing factors, and suggested strategies to de-adopt the follow-up care. The focus groups comprised preferred follow-up schedules and providers as well as content of follow-up. All (group)interviews were transcribed verbatim, and analysed by two researchers using Atlas.ti software. Factors influencing current follow-up care practices among dermatologists included complying with patients' preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow-up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de-adopt the low-value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realising appropriate financial reimbursement and informing dermatologists about the low-value of care. A mixture of factors appear to contribute to current follow-up practices after low-risk BCC. I

Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study

Background: Despite the high and rising incidence rate of keratinocyte cancer (KC) and the importance of incorporating patient values into evidence-based care, few studies have focused on the perspectives of patients with KC. Objectives: To identify the needs and preferences of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) regarding care. Methods: A qualitative study was conducted consisting of three focus groups with patients with BCC and three focus groups with patients with SCC. In total 42 patients participated. In each focus group, the patients’ needs and preferences regarding treatment and follow-up were discussed, using a predefined topic list. All sessions were transcribed verbatim and analysed by two researchers. Results: The following needs and preferences were identified: (i) the need to receive all relevant, tailored information; (ii) a physician who takes you seriously and communicates well; (iii) a short waiting period and the best treatment with direct results; (iv) to be seen by the same physician; a preference for a dermatologist during (v) treatment and (vi) follow-up; (vii) a general need for structured follow-up care and (viii) a full-body skin examination during follow-up. Patients with BCC additionally expressed the need for openness and transparency and wanting to participate in shared decision making. Conclusions: It is advocated to organize skin cancer care that is better tailored to the needs of patients with KC, providing patient-centred care. This should include investing in the patient–physician relationship, and personalizing the type and form of information and the follow-up schedules. Adding the patient's perspective to current guidelines could facilitate this process