DS21 Patients’ experience with one-stop skin cancer clinics

Abstract

Abstract Dermatological surgery has been well integrated into the daily work of a dermatologist, especially in the management of skin cancers. Therefore, dermatologists have to be well prepared to consent patients for their respective surgical procedures. Consent is a medicolegal and ethical requirement prior to any procedure. The General Medical Council has produced guidance outlining seven principles of decision-making and consent. With increasing referrals of suspected skin cancers to secondary care dermatology, it is increasingly common for one-stop clinics to be introduced to tackle the sheer volume—clinics where patients are seen and treated on the same day. There are concerns that such models can diminish patient understanding and the validity of consent. Mr Justice Kearns of the Supreme Court of Ireland stated: ‘As a general principle of good practice, if the treatment is not urgent, patients should be given plenty of time to think about their options before they consent to treatment and be encouraged to ask further questions’. Our department has recently introduced a one-stop skin cancer clinic, and we have conducted a survey to compare patient experiences in those who had same-day skin surgery and those who had a prebooked surgical appointment. The data were collected over a period of 3 months with a total of 80 respondents. All respondents expressed that they had complete understanding of their procedures, 23 of whom had same-day surgery. All 23 respondents who had same-day surgery were comfortable to have same-day surgery, with only six expressing that they felt anxious. When asked if the respondents preferred to have same-day surgery or surgery on other days, 21 of 23 respondents who had same-day surgery preferred to have it on the same day, whereas 34 of 57 of the respondents who had different-day surgery would rather have their surgery on the same day. A total of 69% preferred to have same-day surgery, with three expressing no preference. Our findings reveal that the majority of the respondents preferred to have their procedures on the same day as their clinic consultation and all expressed an adequate understanding of their procedure and felt that they have been given sufficient time to understand and weigh up their options. This suggests that patients have adequate understanding of their procedures, despite being consented and treated on the same day, while also improving their patient experience in a busy department.