Assessing melanoma patients’ satisfaction with treatment and clinical care: preliminary findings from a novel regional pilot program

Introduction

Despite advances in diagnosis and the introduction of modern systemic therapies, melanoma – one of the cancers with a marked increase in newly diagnosed cases in recent decades [1] – remains one of the leading causes of cancer-related mortality worldwide [2]. This unfavourable trend persists despite the identification of several well-established factors influencing melanoma development, such as typical cellular mechanisms and genetic and molecular determinants. Additionally, various preventive initiatives and public health programmes have been implemented in recent years to combat the alarming progression of this challenging disease [3].

The management of melanoma has become a substantial challenge, not only for specialised oncology centres conducting clinical research but also for healthcare systems globally [4]. This challenge is largely driven by the significant financial burden associated with treatment, as well as the need for dedicated melanoma units (MUs) capable of delivering comprehensive, multidisciplinary care tailored to the diverse needs of this complex patient population [5, 6]. Nonetheless, oncological treatment strategies and the implementation of novel therapies must be balanced with a focus on patient-centred outcomes, particularly those related to quality of life [7]. Quality of life is widely recognised as a key determinant of successful outcomes in oncology, both in curative and palliative settings [8]. Several factors influence quality of life, including the minimisation of treatment-related burdens, individualisation of therapeutic strategies, provision of multidisciplinary care, creation of a supportive and comfortable treatment environment, delivery of optimal psychological support, transparent communication regarding the treatment process, and attention to patients’ social and overall well-being [9].

This dimension is especially important for melanoma patients, as supported by numerous systematic reviews that assess the impact of various therapeutic interventions on patient-reported outcomes [10]. In this context, patient overall satisfaction is a crucial aspect. It encompasses not only their satisfaction with the treatment itself but also with ancillary processes such as organisational aspects and living conditions, which are frequently overlooked in everyday clinical practice [11].

Factors influencing overall satisfaction (OS) include the coordination of medical services (e.g., registration and patient pathways), waiting times, competence of medical staff, quality of care provided by physicians and nurses, clarity of discharge instructions, and the integration of patient feedback into clinical decision-making [12].

An essential component of establishing cancer-specific treatment units is the integration of diverse treatment modalities alongside continuous patient education and the evaluation of patient satisfaction with the medical services provided [13]. However, there is a noticeable lack of publications addressing overall satisfaction among melanoma patients treated in highly specialised oncology units.

Aim

The aim of this study was to evaluate patient satisfaction during treatment and clinical care provided in a regional MU, with a focus on assessing the key determinants of overall satisfaction within this context.

Material and methods

The survey was administered to all melanoma patients treated at the Lower Silesian Oncology, Pulmonology, and Haematology Centre (LSOPHC). All subjects and/or their legal guardian(s) in this study gave informed consent. The survey was developed by a team of experts for this study and was approved by the Ethics Committee of the Wroclaw Medical University (Approval number: KB-477/22). It has not been previously published or used in any research. This study was a part of the pilot program implemented in the Lower Silesian Voivodeship (a south-western region of Poland with a population of approximately 2.9 million), although participation was voluntary. The pilot program, which began in May 2020, introduced several new initiatives, including pathological synoptic protocols, quality indicators, and the supervision of a medical coordinator [14].

At the outset, patients were asked to provide basic, non-identifiable demographic information and to indicate whether they had been hospitalized or received outpatient care. They were then asked to rate 34 aspects of their medical care experience at the MU, as outlined in Table 1. The survey covered three key areas: infrastructure and organisation of medical services (Part I), quality of medical care (Part II), and the scope of information provided to patients (Part III). The section on infrastructure and organisation (Part I) was completed only by patients who had been hospitalised. A 4-point scale was used to assess the importance of each aspect to the patient (1 = low priority, 4 = high priority), while a 5-point scale was employed to evaluate patient satisfaction with the implementation of each aspect (1 = very poor, 5 = very good).

At the conclusion of the survey, patients responded to six questions regarding their participation in the pilot program (Part IV). They were also asked: “If any of your family or friends required oncological treatment, would you recommend our hospital?” Responses to this question were rated on a 10-point scale, where 1 indicated “definitely not” and 10 indicated “definitely yes”.

Results

Discussion

The diagnosis and treatment of melanoma have undergone significant advancements over the past decade. Currently, melanoma treatment encompasses a wide array of therapeutic modalities, which are tailored to the disease stage. These range from surgical removal of the tumour, followed by scar excision with plastic reconstruction and concurrent sentinel lymph node biopsy or regional lymph node dissection, to the implementation of systemic regimens that include immunotherapy (anti-PD-L1/2) or various combinations of targeted therapies (iBRAF/iMEK) [1516–17].

For some unresectable melanoma tumours, newer therapies such as electrochemotherapy or stereotactic photon radiotherapy are also utilised [18, 19].

As treatment approaches and regimens evolved, it became evident that melanoma care should be delivered in highly specialised Cancer Centres. These Centres must be equipped with a range of diagnostic tools and the capacity to offer all available treatment options, while ensuring that high-risk patients are subjected to long-term follow-up with the potential for immediate re-evaluation and re-treatment in the event of relapse or dissemination [20, 21].

Globally, MUs have begun to adopt an individual structure based on multidisciplinary teams, consisting mainly of dermatologists, plastic surgeons as well as surgical oncologists, radiotherapists and clinical oncologists [22]. To ensure efficient collaboration and to standardize team workflows, numerous studies and guidelines have been established to facilitate daily clinical practice [23]. Despite these significant developments, there remains a notable gap in universally established protocols for assessing patient satisfaction with melanoma care. A patient’s overall assessment, not only of the treatment process but also of the entire diagnostic and therapeutic journey, is often a crucial factor in optimizing therapeutic outcomes and enhancing the efficiency of care [24].

In this study, patient satisfaction regarding the treatment and clinical care provided in one reference melanoma centre in Wroclaw (Lower Silesian Voivodeship) was evaluated. The study was conducted on a representative sample of patients. The analysis utilized a survey developed as a part of a broader pilot program initiated for the MU. This survey, one of the first of its kind in Poland, allowed melanoma patients to evaluate the comprehensive medical care they received. It was designed according to standard research principles and methods used in similar studies [25, 26].

The satisfaction assessment was divided into four independent sections, enabling patients to thoroughly evaluate the hospital environment and express their needs. In the first section, which focused on infrastructure and treatment organisation, the highest ratings were given to the cleanliness of patient rooms and the responsiveness of nursing staff to patient calls. Both of these factors were found to meet the basic expectations of patients. Cleanliness was particularly emphasized, as it plays a key role in protecting patients from infections, which is crucial in the oncology setting [27]. Additionally, the prompt and always-available response of nursing staff to patient calls contributed significantly to the patients’ sense of safety and psychosocial support throughout their treatment and recovery [28]. On the other hand, the lowest satisfaction levels were observed in relation to the quality of meals and access to bathrooms with toilets. The dissatisfaction regarding meals likely stemmed from the dietary restrictions common in surgical wards, often necessitating bland or restricted diets, which patients typically found unappealing [29]. The lack of toilet facilities in some patient rooms was due to the historic nature of the building housing the surgical department, which was constructed at the turn of the 19th and 20th century.

The second section, which directly focused on aspects of medical care, revealed that patients were most satisfied with the courtesy and kindness of the doctors and the prompt response of medical staff to reported pain. Conversely, the lowest ratings were attributed to personal interactions with the attending physician. Interestingly, these ratings were complementary; patients generally expressed satisfaction with the quality of initial contact with their physician and appreciated their support in critical situations (e.g., pain management), but they expressed a desire for more frequent and extended interactions. This limited contact was primarily due to the global shortage of healthcare professionals and the particular nature of work in surgical wards, which often restricts the time available for patient-physician interactions [30].

The third analysed part of the survey, which addressed the scope of information provided to patients, showed that patients were most satisfied with clear information about scheduled examinations and easy access to their medical records. However, they expressed dissatisfaction with the emotional support provided by medical staff and with the information regarding the potential impact of melanoma on their overall health. These findings likely reflect the anxiety and uncertainty experienced by cancer patients, who often seek comprehensive and clear information about their prognosis and the impact of their condition on their well-being [31].

In the final section, which directly pertained to the pilot program itself, more than half of the respondents felt that the program provided adequate care in a timely manner. However, nearly the same proportion of patients reported that treatment was implemented either very quickly or too late. These mixed responses may be attributed to the heterogeneity of the sample, particularly with regard to the melanoma stage. Patients with early-stage melanoma might have been less concerned about potential delays in treatment than those with advanced disease [32].

The above analysis used a questionnaire prepared and developed specifically for the study (Supplementary 1).

A valuable direction for future research could be the expansion of the survey to include elements from Patient-Reported Outcome Measures (PROMs) [33]. The development of a new survey incorporating PROMs, along with the data gathered in this pilot study, could provide valuable insights into the objective assessment of the diagnostic, treatment, and hospital care processes for melanoma patients.

Conclusions

Following this research project, a clear assessment of satisfaction with the diagnostic process, treatment and medical care among melanoma patients was obtained. This study assessed elements related to perceptions of medical care at both psychosocial and clinical levels. The pilot program clearly showed a high level of satisfaction among patients treated in the specialised MU. In each of the analysed sections of the program, significant issues reported by patients were identified, highlighting areas that require immediate attention and improvement.

These findings offer valuable insights that could help enhance the quality of care and patient satisfaction in other MUs. However, the authors acknowledge that the results are subject to certain limitations, as they are based on a selected group of patients treated at a single regional Cancer Centre. This may influence the evaluation of specific parameters within the survey.