Factors influencing low‐value follow‐up care after BCC

Abstract

Basal cell carcinoma (BCC) is the most common type of cancer worldwide and its incidence is still rising. It is a type of skin cancer, but it is generally slow‐growing and very rarely spreads elsewhere in the body. Currently, guidelines recommend to only provide follow‐up care (e.g. annual check‐ups) to BCC patients considered ‘high risk’ according to certain factors, such as the size of the tumour, its location, and if it was faster growing than normal. However, dermatologists still provide follow‐up care to patients with low‐risk BCCs as well. To understand why this so called ‘low‐value care’ is provided and to identify strategies to reduce this care, the Dutch authors (based in Rotterdam) interviewed 18 dermatologists and organised three focus groups with 17 low‐risk BCC patients. The interviews and focus groups were audio taped and then transcribed literally. These transcripts were then loaded into a software programme and analysed for themes. Two main reasons given by dermatologists for providing low‐value follow‐up care were: i) complying with patient preferences and ii) a lack of trust in general practitioners (GPs) to identify suspicious lesions (possible skin cancers). Financial incentives and force of habit were two further reasons. Patients also expressed a lack of trust in GPs, and whereas some of the BCC patients preferred receiving periodic follow‐up care, other patients felt it was unnecessary. Several strategies for reducing follow‐up care were suggested, of which educating patients was identified as potentially effective by dermatologists and patients. Results of this study have already been incorporated in a pilot study, in which BCC patients receive written information which includes information about their disease, treatment, recurrence chance and chance of subsequent BCC. This letter is tailored to their specific situation.