Information Leaflets Research Articles

916 Introducing a New Guideline for the Fifth Metatarsal Fracture (5th MTF)

Abstract Background The 5th MTF is a common injury occurring in the long bone joining the ankle to the toes. This injury can be categorised into two main sub-sections, namely green zone fractures (GZF) and red zone fractures (RZF) which are treated differently. Moreover, patients suffering from uncomplicated GZF are to be discharged directly from emergency department (ED), whereas the complex cases require a review from orthopaedic doctors. Due to time-restraint in ED, some fractures might be misdiagnosed/referred directly to fracture clinics unnecessarily. Aim Increase ED-led management and discharge of patients suffering from GZF Method A QI was introduced to implement a new guideline and update the patient information leaflet in the emergency department at ELHT. For each set of baseline data, an intervention was suggested to achieve the goal of this project and ensure a safe discharge of patients from ED. Results During a four-week study period, 20 patients presented to ED with an uncomplicated green zone fracture, 40% of which were discharged directly from ED. This demonstrates an improvement of 12.7% from a baseline of 27.3%. In addition, 80% of these patients were managed with a walker boot, as mentioned in the new guideline. In total, only three fracture clinic appointments were booked, due to complications, as opposed to twenty appointments. This resulted in a saving of £1.835,4. Conclusions The new guideline has led to an improvement of 50% in patient care. The new management plan benefits patients and improves the efficacy of the ED as well as fracture clinics.

Responding to Urinary Tract Infection Symptoms in England's Community Pharmacies.

Most urinary tract infections (UTIs) are self-limiting and frequently present in primary care; it is common for patients to seek symptom relief. The TARGET Treating Your Infection (TYI) leaflet was used to respond to UTI symptoms for women under 65 years presenting in community pharmacies. The widespread use of these leaflets was incentivised as part of NHS England's Pharmacy Quality Scheme (PQS) 2022-23, between October 2022 and March 2023. The TARGET TYI leaflets are aimed to support appropriate antibiotic use and antimicrobial stewardship (AMS) as well as reducing the opportunity for resistance to develop. A total of 8363 community pharmacies completed the AMS criteria within the PQS and collectively submitted data for 104,142 patients presenting with UTI symptoms. The majority, 77% (75,071), of (non-pregnant) women presented with none or only one of the three strongly predictive symptoms of dysuria, new nocturia, cloudy urine, and/or vaginal discharge and, therefore, were less likely to have a UTI, as outlined in the English UTI diagnostic guidance. Conversely, 23% (22,381) of women presented with two or more symptoms of dysuria, new nocturia, cloudy urine, and with no vaginal discharge and, therefore, they were more likely to have a UTI. The TARGET TYI UTI leaflets support community pharmacy teams to differentiate between symptoms more likely to be associated with UTIs and those that could be managed with self-care. The findings suggest that most women presenting to community pharmacies with urinary symptoms were likely to have self-limiting symptoms, and could be suitably managed with self-care, pain relief, and appropriate safety netting. Approximately one-third of patients were managed by community pharmacy team members without the need for referral to a pharmacist and one in five patients presented with escalation symptoms and were signposted to other healthcare settings. A total of 94% (97,452) of women received self-care advice of which 36% (37,565) were also provided with additional patient information leaflets.

338 Wide-Awake Hand Surgery in Trauma: Optimising Patient Experience and Strategies to Advance Patient Care

Abstract Background Our regional hand trauma unit in Greater Manchester underwent significant service reorganisation from predominantly GA to WALANT early in the COVID-19 pandemic. We implemented a variety of strategies to optimise patient care and maintain adherence to national standards. Here, we present a review of these strategies. Method Five domains throughout the patient pathway were explored, with chi-square and student t-testing used to assess significance. Results ‘Time-to-treatment’ compliance with national standards were maintained following reorganisation, with an improvement in compliance for extensor tendon repairs. A pre-operative information leaflet resulted in significant improvements in patient knowledge and anxiety levels. A knowledge-gap in post-operative analgesia administration amongst patients was identified and addressed through a standardised protocol and supplemental written guide to optimally manage peak post-operative pain. Additionally, the shift of our services to our ambulatory unit has resulted in a significant in reduction in our theoretical carbon footprint through reduced patient travel and gaseous anaesthesia use. Conclusions Despite dramatic service reorganisation to a primarily WALANT service, we have demonstrated a multi-faceted approach to optimise the patient journey, whilst upholding compliance with national standards and reducing our overall ecological footprint.

Patient education: a colourful read?

Focus has been placed on improving ethnic and racial equality in dermatology in a number of areas including publishing and medical education, but what about patient education? In this letter, we analyse skin of colour representation in patient information leaflets from a number of dermatological bodies around the world.

ThTP1.5 Evaluating the Impact of Electronic Documentation on the Consent Process for Whipples Procedures within a HPB Department

Abstract Background The Whipples is an operation associated with major morbidity. Common risks include infection, wound problems and delayed gastric emptying. Less common but significant complications include fistula, anastomotic leak and cardiorespiratory dysfunction. This often requires intensive care or further procedures. Overall, mortality is 3%. This wide array of possible post-operative outcomes must be documented accurately on a consent form. However, what is stated often varies significantly depending on the consenting clinician. We assess the effect of a transition to an entirely electronic patient record (EPR) system on the consent process and the subsequent impact of standardised electronic consent forms. Methods Comparison of documented risks and additional procedures against ideal consent adapted from a patient information leaflet for Whipples. Cases performed by a tertiary centre hepatobiliary surgery department. Paper consent forms from July to September 2022 compared to electronically signed consent forms obtained from the EPR system from September to November 2022. Intervention in December 2022 (automated consent form). Re-audit from December 2022 to January 2023. Descriptive statistical analysis. Results 25 consent forms assessed. Majority of forms completed by middle grades (92%). Eighteen documented risks and four additional procedures in ideal consent. Complications such as bleeding, infection and cardiorespiratory complications consistently feature in consent forms. Transition to electronic system meant most additional procedures documented less frequently, as are other complications such as visceral injury. Broad improvements in consenting documentation following intervention. Conclusions Introduction of pre-filled consent forms produced swift and significant improvements in consistency of consent forms. Further assessment of other index procedures of hepatobiliary, general and vascular surgery to follow.

Co-production of guidance and resources to implement principled participant information leaflets (PrinciPILs).

The way information about potential benefits and harms of trial is presented within participant information leaflets (PILs) varies widely and may cause unnecessary 'nocebo' effects. The Medical Research Council (MRC) funded a project that developed seven principles to reduce this variation. However, guidance has not been produced to facilitate the implementation of the principles. Stakeholder involvement is recommended to optimise the way these principles are disseminated and explained. To co-produce recommendations for developing: (1) user-friendly guidance for users of the principles; and (2) resources that support the implementation of the principles. We held a co-production workshop with representation from the following professional groups: the Health Research Authority (HRA), research ethics committee members, and trial managers. Two rounds of discussions focused on generating recommendations for guidance and resources that support the implementation of the seven principles. Extensive low inference style ethnographic notes were taken, and the data were analysed thematically using deductive codes. The data was collected on October 14, 2022. 25 participants attended a hybrid workshop. Participants recommended that both researchers designing PILs and research ethics committee members should use the principles, and that that they should be simple, mention both benefits and harms explicitly, include examples of visual representations, and provide the evidence base for the principles. We were able to co-produce recommendations for developing and implementing the seven principles within PILs. These recommendations can now be implemented to reduce unexplained variation in the way potential benefits and harms are shared within PILs.

ThTP7.3 Do patients receive written information? An overview of the management of acute uncomplicated diverticulitis

Abstract Background The management of acute uncomplicated diverticulitis was audited in compliance with NICE, the World of Society of Emergency Surgery and the Association of Coloproctology of Great Britain and Ireland guidelines. Included was the advice for appropriate written information. The initial cycle found no consistency in written advice if given at all. This audit analysed the compliance of providing written information to patients with acute diverticulitis. Following the initial cycle identifying significant discrepancies between patients, a secondary aim was formed to publish a standardised patient information leaflet. Method 50 consecutive patients presenting to A&E with CT-proven uncomplicated acute diverticulitis were included. If any, advice on discharge was assessed for topics and consistency. Other factors were considered including if discharged directly from A&E or antibiotic administration. Results The mean age of patients was 58.4 years. 30 patients were admitted, 20 were discharged from A&E. 41 patients received antibiotics. All patients were Modified Hinchey Classification 1a or 1b. 21 patients had no documented written advice on discharge. Most commonly, the advice given was to seek medical attention or return to hospital if increasingly unwell (eight) or dietary advice while in acute infection (12). Conclusion Almost half of patients had no written advice and there was no consistency in the other half. A standardised approach was required hence the need for the patient information leaflet to be created. This includes all topics recommended by guidelines and ensures no information is missed for patients. The leaflet is now published.

Efforts to Improve the Accuracy of Information About Electroconvulsive Therapy Given to Patients and Families

Objective:Many thousands of people still receive electroconvulsive therapy but it remains highly contested. A recent audit of the United Kingdom patient information leaflets found multiple inaccuracies and omissions, minimizing risks and exaggerating benefits (e.g., only six leaflets mentioned cardiovascular events). This study reports efforts to improve accuracy for patients and families.Methods:Letters were sent twice to managers of all 51 United Kingdom National Health Service trusts (regional bodies which deliver most health care) detailing the audit’s findings and the accuracy of their own trust’s leaflet, also asking what changes would be undertaken.Results:Only nine trusts responded and three committed to improvements. The Royal College of Psychiatrists released a slightly better but still highly misleading information sheet. Efforts to engage government and all other relevant United Kingdom bodies failed.Conclusions:Trusts are unwilling to correct misinformation/ensure balanced information.

Improving health literacy of antifungal use-Comparison of the readability of antifungal medicines information from Australia, EU, UK, and US of 16 antifungal agents across 5 classes (allylamines, azoles, echinocandins, polyenes, and others).

Adherence to antifungals is poor in high endemic regions where antifungal resistance is high. Poor readability of prescription/over-the-counter (OTC) antifungals may contribute to poor adherence, due to the patient not fully understanding the purpose, importance, and dosage of their antifungal medicine. As there are no reports on the readability of antifungals, this study examined the readability of patient-facing antifungal information. Antifungals (n=16; five classes [allylamines, azoles, echinocandins, polyenes, and others-flucytosine and griseofulvin]) were selected. Readability of four sources of information, (i) summary of product characteristics, (ii) patient information leaflets (PILs), (iii) OTC patient information, and (iv) patient web-based information, was calculated using Readable software, to obtain readability scores [(i) Flesch Reading Ease [FRE], (ii) Flesch-Kinkaid Grade Level [FKGL], (iii) Gunning Fog Index, and (iv) Simple Measure of Gobbledygook (SMOG) Index) and text metrics [word count, sentence count, words/sentence, and syllables/word]. PILs, web-based resources, and OTC patient information had good readability (FRE mean±sd=52.8±6.7, 58.6±6.9, and 57.3±7.4, respectively), just falling short of the≥ 60 target. For FKGL (target≤8.0), PILs, web-based resources, and OTC patient information also had good readability (mean±sd=8.5±1.0, 7.2±0.86, and 7.8±0.1, respectively). Improved readability scores observed correlate with reduced words, words/sentence and syllables/word. Improving readability may lead to improved patient health literacy. Healthcare professionals, academics, and publishers preparing written materials regarding antifungals for the lay/patient community are encouraged to employ readability calculators to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy of their patients/readers.

The utility of the ChatGPT artificial intelligence tool for patient education and enquiry in robotic radical prostatectomy.

To assess the ChatGPT (Open AI) artificial intelligence platform's utility and accuracy as a patient education tool in robotic-assisted radical prostatectomy. The ChatGPT 3.5 interface ( https://chat.openai.com/chat ) was interrogated and asked the 14 questions related to the frequency of complications of robotic-assisted radical prostatectomy as listed on British Association of Urological Surgeons (BAUS) patient information leaflet "Robotic-Assisted Laparoscopic Radical Prostatectomy)" published July 2021. The AI's responses to each question were tabulated, and compared alongside the official figures quoted from the BAUS information leaflet. A global assessment of the AI's response was also made for accuracy and relevance to patients. Of the 14 questions asked, 11/14 (78.6%) of ChatGPT's quoted figures were considered concordant and comparable to those quoted by the BAUS patient information leaflet. 13/14 (92.9%) of ChatGPT's responses were globally assessed to contain accurate information, appropriate, and pertinent to a patient's potential enquiry. ChatGPT is a powerful tool and is able to generate accurate and helpful information for patients seeking information regarding urological procedures and their potential complications. It is not, however, infallible, and urologists should remain vigilant in their patient interactions to any potential misinformation a patient may have gathered from it in their personal research prior to surgery.

Vaginal birth core information set: study protocol for a Delphi study to achieve a consensus on a ‘core information set’ for vaginal birth

IntroductionStudies have shown that women are often underinformed about potential benefits and risks of vaginal birth. This is in contrast to other modes of birth, such as caesarean birth, for...

Using a theory-informed approach to guide the initial development of a post-tuberculosis care package in British Columbia, Canada

BackgroundThe importance of addressing the long-term needs of tuberculosis (TB) survivors is gaining increasing attention. One promising approach to improving post-TB care is implementing a post-TB care package. With a specific focus on the perspectives of healthcare providers in British Columbia, Canada, this study aimed to (1) determine a set of components to be included in a post-TB care package, (2) explore barriers and facilitators influencing their implementation, and (3) propose potential solutions to overcome identified challenges.MethodsEmploying a multi-method approach guided by the Theoretical Domains Framework, we first conducted virtual workshops with TB care providers and utilized a modified Delphi process to establish a preliminary list of care package components. Then, we surveyed healthcare providers using closed-ended, Likert-scale questions to identify implementation barriers and enablers. Lastly, we mapped the identified barriers and enablers to establish behaviour change techniques to identify possible solutions to overcome the challenges identified.ResultsEleven participants attended virtual workshops, and 23 of 51 (45.1%) healthcare providers completed questionnaires. Identified components of the post-TB care package included:1. Linking people with TB to a primary care provider if they do not have one.2. Referring people with pulmonary TB for an end-of-treatment chest x-ray and pulmonary function testing.3. Referring people with TB who smoke to a smoking cessation specialist.4. Sharing a one-page post-TB information sheet with the patient's primary care provider, including a summary of post-TB health concerns, complications, and recommendations to prioritize age-appropriate screening for cardiovascular disease, lung cancer, and depression.Survey results indicated that domain scores for ‘environment, context, and resources’ were the lowest, suggesting potential implementation barriers. Care navigation services to help individuals overcome health system barriers while transitioning from TB care, information leaflets, and checklists summarizing key post-TB health concerns for patients and healthcare providers to help facilitate discussions may help overcome the identified barriers.ConclusionHealthcare providers in British Columbia acknowledge that post-TB care is integral to comprehensive health care but are limited by time and resources. Care navigation services, a post-TB checklist, and patient information leaflets may help resolve some of these barriers.

Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment.

Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence. To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs. We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet. There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component. The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.

An independent audit of electroconvulsive therapy patient information leaflets in Northern Ireland, Scotland and Wales.

To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent. To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit. The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the 'most effective treatment' and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives. Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.

Multimodal Analysis of Selected Health Awareness Materials: A Visual Grammar Approach

The Visual Grammar approach is effective in examining the communicative value of healthcare posters. As semiotic resources, these posters comprise both images and text for persuasive and informative ends. Previous studies have looked at multilingual health care texts and medical information leaflets using different approaches, but the focus here was monolingual healthcare posters written in English. Hence, this study analyzed five purposefully selected online healthcare posters meant for a Nigerian audience. It looks at the ways image and text cohere as syntagm within narrative and conceptual representations to form persuasive and informative messages, and the multimodal constraints on the healthcare posters as they serve communicative ends. A descriptive research design was adopted to analyse corpus from five online health care materials. Features of the materials were identified and classified according to manifested multimodal features before they were subjected to narrative and conceptual analyses. The way image and text cohere; their functions and communicative values were also discussed to highlight attendant constraints. Findings show that as a multimodal text the healthcare posters employ semiotic resources to project messages as either contextualized or decontextualized. Major and minor semiotic processes, achieved by image and text coherence, form both narrative and conceptual meaning-making units. Added to this informative value are colour variations and font size which are also employed as enhancers of detail, mood and contrast as well as attention drawing devices. Logos of sponsors give the health messages varying credibility values as rhetorical questions and advice-clauses serve persuasive ends. Thus, the study concluded that the communicative potential of a healthcare poster are hinged on semiotic resources that constrain readers’ or viewers’ perceptions on health matters.

“I think this could be a big success” – A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI

IntroductionA key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice. MethodsA mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use. ResultsPerceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development. ConclusionThe practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time. Implications for practiceUse of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.

A study to assess the knowledge on Infant and Young Child Feeding (IYCF) practices among the mothers of rural and urban area of Kolar district with a view to develop information leaflet

A study to assess the knowledge on Infant and Young Child Feeding (IYCF) practices among the mothers of rural and urban area of Kolar district with a view to develop information leaflet

Perspective of Dutch healthcare professionals on care for female urinary incontinence: a mixed-methods study.

Urinary incontinence (UI) impacts patients and society in many ways. There are good treatment options, but healthcare delivery and processes are often suboptimal. Healthcare professionals (HCPs) can reveal practical recommendations to improve processes and address challenges in the care of women with UI in the Netherlands. We conducted an exploratory, sequential, mixed-methods study among HCPs, using outcomes of five focus group sessions (30 HCPs) to inform a subsequent survey. HCPs included GPs, practice assistants (PAs), pelvic physiotherapists (PPTs), and urologists and gynecologists (UGs). Main themes arising from the five focus group sessions (with six GPs, seven PAs, six (resident) UGs, eight PPTs, and seven PPTs) were 'identification of UI', 'current state of care', and 'guiding patients through the healthcare system'. Survey responders (n = 741) included 351 PAs, 124 GPs, 75 PPTs, and 183 UGs. Overall, 72.8% (strongly) agreed that the identification of UI required improvement and 60% confirmed the need for further education. Most HCPs (83.1%) found it useful to offer a patient information leaflet when buying incontinence products but less useful to ask about UI routinely, and most (75%) agreed that a multidisciplinary guideline could improve health care. Interestingly, 86% of PPTs and 21% of UGs advocated referral to a PPT before referral to a specialist, while 87% of PPTs wanted primary care services to offer a UI consultation hour and 36% of the GPs (strongly) disagreed. Poor UI identification in primary care and a lack of patient guidance through the healthcare system hamper continence care provision.

BC03 Skincare in acne: are we letting our patients down?

Abstract Acne vulgaris is a chronic and recurrent inflammatory condition of the pilosebaceous unit. A combination of topical and systemic agents is often required to achieve symptom control, improve quality of life and reduce the risk of scarring. The role of skincare products in the management of acne has been well defined in the literature as a key adjunct to other therapies. We conducted an observational retrospective study to explore the patient experience of acne skincare advice provided by their dermatologist. Patients in the acne clinic, to which they would be referred for treatment with oral isotretinoin, were invited to participate. A survey incorporating multiple choice questions and an open comment box was distributed electronically. Twenty-nine per cent of patients acknowledged the importance of skincare products in managing their acne. Only 39% of respondents felt they had the opportunity to discuss skincare during their consultation. Over 86% of patients had been prescribed oral isotretinoin at least once; however, 60% had not received any skincare advice from their dermatologist. Only 31% of patients felt more confident with their skincare routine after their dermatology consultation than they did before. The internet and social media were the most popular sources of information for accessing skincare advice, with over 77% of patients identifying it as their main informant. Yet the majority of patients (88%) were likely to adhere to skincare advice if instructed by their dermatologist, clearly preferring this to social media. The most recurring theme from open comments was the desire to discuss skincare with their dermatologist and get signposted to a more reliable source of information for skincare. The data suggest that clinicians are failing to address or discuss skincare with patients, leaving them at the mercy of social media and at risk of exposure to scientifically unproven or incorrect advice. Integrating such advice when reviewing patients with acne would not only help with the management of their condition post-treatment with oral isotretinoin but also improve patient satisfaction and avoid misinformation. As a single-centre study, our results may not be representative of all patients, and the data collected were dependent on patient recall. Our results highlight the need for dermatologists to disseminate evidence-based skincare advice specific to acne-prone skin to their patients. Going forward, we aim to provide all our patients with acne with an information leaflet on skincare to complement their medical treatment.

DS06 Does the content of patient information leaflets reflect real-life practice? A comparison of four patient information leaflets in Mohs micrographic surgery

Abstract In our experience, patients referred for Mohs micrographic surgery (MMS) often have unrealistic expectations, anticipating defects that are small in size and depth, and incorrectly describe the procedure as removal of skin cancer by ‘taking away thin slices’ or ‘skimming the skin layer by layer’. This observation prompted us to critically appraise four widely accessed online patient information leaflets (PILs) on MMS produced by the British Association of Dermatologists, the American Academy of Dermatology, Dermnetnz.org and the European Society of Micrographic Surgery. Our aim was to evaluate the wording used and propose evidence-based changes to help manage patients’ expectations. We focused on two core themes: (i) excision of tumour by MMS, including the number of stages, and (ii) cosmetic benefit of MMS over standard excision (SE). All of these PILs state the need for ‘stages’ to achieve margin clearance, with an initial margin of excision as low as 1 mm per stage mentioned in one PIL. The leaflets suggest cosmetic benefit and tissue preservation of MMS over SE, and one leaflet ranked this higher than other advantages offered by MMS. We feel that these points are overstated and better addressed with evidence-based facts. Studies have shown that 60% of cases of MMS are cleared in one stage; &amp;gt; 90% of tumours are cleared within two stages, and the number of patients needing three or more stages is only 6% (Macfarlane L, Waters A, Evans A et al. Seven years’ experience of Mohs micrographic surgery in a UK centre, and development of a UK minimum dataset and audit standards. Clin Exp Derm 2013; 38:262–9). In our experience, a surgical margin of 1 mm is not feasible in MMS. There is no direct evidence that MMS improves cosmesis compared with SE (Brown AC, Brindley L, Hunt WTN et al. A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794–804). Cosmetic and functional outcomes are usually only relevant in high-risk sites (e.g. the central face H zone) and in certain high-risk tumours where wide local excision would be the alternative treatment. In conclusion, we propose that PILs in MMS should avoid using misleading language like ‘thin’ and ‘small’ when describing the procedure. Patient information leaflets should clarify that the vast majority of tumours are cleared after two stages rather than requiring multiple stages. Tissue sparing should not be highlighted as the main advantage of MMS, and patients should not be pledged small wounds and better cosmetic outcomes.