School of Public Health, Sydney Medical School, The University of Sydney, NSW, Australia.
Eur J Surg Oncol. 2013 Mar;39(3):297-303. doi: 10.1016/j.ejso.2012.12.017. Epub 2013 Jan 1.
Little is known about the value of long-term follow-up for localised cutaneous melanoma from the patients' perspective. This study aimed to explore the benefits and potential downsides of follow-up; feelings about changes to frequency of follow-up, and patient-centred recommendations for improving follow-up care.
Qualitative analysis of 29 in-depth interviews conducted with Australian patients undergoing long-term follow-up after surgical treatment of stage I/II melanoma.
Patient-perceived benefits of follow-up included reassurance, early detection of new melanomas and non-melanoma skin cancers, education about skin self-examination, the opportunity to ask questions, and reinforcement of 'sunsafe' behaviours. Downsides included anxiety leading up to and during follow-up visits; inconvenience of travel to attend visits; and lost work time. Patients varied in their engagement with skin self-examination, and their views on multiple skin excisions, but highly valued access to specialists for unscheduled visits. Most patients felt their follow-up intervals could be extended to 12 months if recommended by their clinician.
The benefits and potential downsides of follow-up should be discussed with patients when deciding on a melanoma follow-up plan to achieve a balance between inducing additional patient anxiety and providing reassurance. Follow-up intervals of 12 months appear to be acceptable to patients.
从患者的角度来看,对于局限性皮肤黑色素瘤的长期随访的价值知之甚少。本研究旨在探讨随访的益处和潜在弊端;对随访频率变化的感受,以及改善随访护理的以患者为中心的建议。
对 29 名澳大利亚患者进行了深入访谈,这些患者在接受手术治疗 I/II 期黑色素瘤后正在进行长期随访。
患者认为随访的好处包括安心、早期发现新的黑色素瘤和非黑色素瘤皮肤癌、皮肤自我检查教育、提问机会,以及强化“不安全”行为。缺点包括随访就诊前和就诊期间的焦虑;旅行就诊的不便;和失去工作时间。患者对皮肤自我检查的参与程度以及对多次皮肤切除术的看法各不相同,但非常重视为非计划性就诊提供专科医生的服务。大多数患者认为,如果他们的临床医生建议,他们的随访间隔可以延长至 12 个月。
在决定黑色素瘤随访计划时,应与患者讨论随访的益处和潜在弊端,以在增加患者焦虑和提供安心之间取得平衡。12 个月的随访间隔似乎可以被患者接受。