McLaughlin Scott J P, Kenealy John, Locke Michelle B
Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of Plastic, Reconstructive and Hand Surgery, Counties Manukau District Health Board, Auckland, New Zealand.
ANZ J Surg. 2018 May;88(5):474-479. doi: 10.1111/ans.14110. Epub 2017 Oct 11.
Many plastic surgery departments in Australasia have experienced increasing referrals for management of skin lesions. This has driven a demand for new strategies to decrease patient waiting time and administrative costs. The aim of this study was to determine if a purpose-built See and Treat skin cancer clinic could provide a faster skin cancer treatment pathway with comparable clinical outcomes and acceptability to patients.
This was a prospective observational study of patients treated through the See and Treat clinic with a retrospective control cohort. The prospective 'See and Treat' cohort included a consecutive series of 106 patients, while the retrospective cohort included a consecutive series of 200 patients. Patient demographics, time from referral to surgery and operative measures were analysed. One hundred patients in the prospective cohort completed an anonymous satisfaction survey regarding their treatment.
The average time from referral to surgery was reduced from 121 days in the retrospective cohort to 60 days in the See and Treat cohort (P < 0.001). Rates of complete excision of malignant and premalignant lesions were not different between the two groups, being 93% (178/191) and 91% (76/84), respectively (P = 0.609). Ninety-five percent (95/100) of patients were satisfied with their See and Treat experience overall.
We show that a considerable reduction in the time between referral and surgery can be achieved through a See and Treat clinic without compromise of the success of surgical treatment. Moreover, such a treatment pathway has been shown to be acceptable, and largely preferable, to patients.
在澳大拉西亚地区,许多整形外科部门接收的皮肤病变管理转诊患者数量不断增加。这推动了对新策略的需求,以减少患者等待时间和行政成本。本研究的目的是确定专门设立的“即诊即治”皮肤癌诊所是否能提供更快的皮肤癌治疗途径,同时保证临床效果相当且患者接受度良好。
这是一项对通过“即诊即治”诊所治疗的患者进行的前瞻性观察研究,并设有回顾性对照队列。前瞻性的“即诊即治”队列包括连续的106例患者,而回顾性队列包括连续的200例患者。分析了患者的人口统计学数据、从转诊到手术的时间以及手术指标。前瞻性队列中的100例患者完成了关于其治疗的匿名满意度调查。
从转诊到手术的平均时间从回顾性队列中的121天减少到“即诊即治”队列中的60天(P < 0.001)。两组之间恶性和癌前病变的完整切除率没有差异,分别为93%(178/191)和91%(76/84)(P = 0.609)。95%(95/100)的患者对其“即诊即治”体验总体满意。
我们表明,通过“即诊即治”诊所可以显著减少转诊到手术之间的时间,同时不影响手术治疗的成功率。此外,这种治疗途径已被证明对患者是可接受的,而且在很大程度上更受患者青睐。