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Physician-Centered Outcomes for Skin Cancer Treatment

A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management

Rossi, Anthony M. MD*,†; Sobanko, Joseph MD; Lawrence, Naomi MD§,‖; Bordeaux, Jeremy MD; Cartee, Todd MD#; Armbrecht, Eric S. PhD**; Behera, Anit PhD**; Baum, Christian L. MD††; Alam, Murad MD, MBA‡‡; Maher, Ian A. MD§§

doi: 10.1097/DSS.0000000000001835
Original Article

BACKGROUND Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care.

OBJECTIVE To identify gaps between patient and physician attitudes toward skin cancer outcomes.

MATERIALS AND METHODS A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer–related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings.

RESULTS A list of 53 skin cancer treatment–related themes and outcomes was generated. Eight items were ranked by physicians as “very high” (>80% importance), 5 as “high” (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance.

CONCLUSION Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care.

*Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York;

Weill Cornell Medical College, New York, New York;

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania;

§Center for Dermatologic Surgery, Cooper University Hospital, Camden, New Jersey;

Department of Dermatology, Rowan University, Camden, New Jersey;

Department of Dermatology, Case Western Reserve University and University Hospitals, Cleveland, Ohio;

#Penn State Health, Hershey, Pennsylvania;

**Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri;

††Department of Dermatology, Mayo Clinic, Rochester, Minnesota;

‡‡Department of Dermatology, Northwestern University, Chicago, Illinois;

§§Department of Dermatology, University of Minnesota, Minneapolis, Minnesota

Address correspondence and reprint requests to: Anthony M. Rossi, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, 16 East 60th Street, 4th Floor, New York, NY 10022, or e-mail:

Supported by an institutional research contract from the Patient-Centered Outcome Research Initiative. This research was funded in part through the PCORI ASDS Grant and the NIH/NCI Cancer Center Support Grant P30 CA008748.

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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