Improving knowledge of Mohs surgery in patients and families with 3D-printed models and video animation: A survey-based cohort study

Abstract

To the Editor: Despite its frequency of use, Mohs micrographic surgery (MMS) remains unfamiliar to many patients and can be anxiety provoking for them and their loved ones.1Kamangar F. Petukhova T.A. Monico G. et al.Anxiety levels of patients undergoing common dermatologic procedures versus those seeking general dermatologic care.Dermatol Online J. 2017; 23 (13030/qt64d8r1gp)Crossref Google Scholar Because MMS is performed in the ambulatory setting, it is important for physicians to effectively educate patients so they are better able to give full informed consent and comply with procedure instructions. However, most available educational materials are either not accessible enough or too complex for patients (above the recommended sixth grade reading level).2Vargas C.R. DePry J. Lee B.T. Bordeaux J.S. The readability of online patient information about Mohs micrographic surgery.Dermatol Surg. 2016; 42: 1135-1141Crossref PubMed Scopus (6) Google Scholar As a result, new methods are needed to educate patients before MMS procedures. We developed 2 3-dimensional (3D) models of skin cancers and an educational video module. Accompanied by a script written at a sixth-grade level, the 2 3D models (Fig 1) demonstrate differing patterns of tumor growth: the orange model is a nonaggressive tumor that can be removed in 1 stage, and the pink model is an aggressive tumor requiring multiple MMS stages. The educational video is a 4-minute high-definition animated illustration of the MMS technique, visually describing it in easily approachable language and subtitles (see Supplemental Video 1).3Benedetto P.X. Poblete-Lopez C. Mohs micrographic surgery technique.Dermatol Clin. 2011; 29: 141-151Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar In this unmatched cohort study, 124 patients were enrolled from 2018 to 2019, along with 42 family members. On the surgical day, all patients viewed the video; a subgroup (n = 58) also viewed the 3D models. For patients who viewed both modalities, the video was shown before the 3D models. All 42 family members viewed both the educational video and 3D models. A 5-question survey administered before and after the intervention assessed knowledge of and indications for MMS, as well as participant anxiety and comfort during the ambulatory surgery day on a scale from 1 to 5. For participants who also viewed the 3D model, an additional sixth question assessed if the 3D model in addition was helpful (yes/no). For participants who viewed the video module, a Wilcoxon signed rank test was performed (SAS 9.4; SAS Institute Inc, Cary, NC) to compare preintervention and postintervention survey responses. A P value of less than .05 was considered statistically significant. The percentage of participants who found the 3D models beneficial was calculated. We found a statistically significant improvement in survey scores across all 5 questions for patients (P < .001) and family members (questions 1–4: P < .001; question 5: P = .002) on the postintervention survey. Overall, 92% of participants who viewed the 3D model found this helpful, but there was no statistically significant difference in survey improvement between patients who viewed only the video and patients who viewed both the video and 3D models. To our knowledge, this is the first study examining effectiveness of a combination 3D model and educational video approach in improving comfort and reducing anxiety in not only patients but also accompanying family members.4DeMarco D.V. Ellis J. 3D modeling and Mohs surgery: a novel approach to medical and patient education.Dermatol Surg. 2018; 44: 1646-1647Crossref PubMed Scopus (4) Google Scholar,5Biro M. Kim I. Huynh A. Fu P. Mann M. Popkin D.L. The use of 3D-printed models to optimize patient education and alleviate perioperative anxiety in Mohs micrographic surgery: a randomized controlled trial.J Am Acad Dermatol. 2019; 81: P1339-P1345Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Small sample size, the possibility of selection bias (although all consecutive patients were offered participation), and no distinction made between patients having first-time MMS and patients with prior MMS experience were limitations. Based on these results, we believe this video module and 3D models could be included in a comprehensive set of educational materials before MMS procedures in the future. We would like to acknowledge and thank Steve Morin, instrument maker in the Minneapolis Adaptive Design & Engineering Program, for volunteering to produce the first 3D prototype of the model used in this study. https://www.jaad.org/cms/asset/163789db-f8ca-4991-9e8c-0adec8edf846/mmc1.mp4Loading ... Download .mp4 (28.77 MB) Help with .mp4 files Supplemental Video 1