The Dutch basal cell carcinoma (BCC) guideline recommends that annual checks are only necessary for high-risk BCC patients, and not for low-risk BCC patients. The guideline does recommend giving a generic information leaflet and instructing the patient on self-examining their skin.
However, many low-risk BCC patients still receive unnecessary follow-ups. Since BCC is the most common cancer in the Netherlands and the incidence continues to increase by 5% per year, this low-value care can put pressure on the dermatologists’ waiting lists.
This project aims to develop and test a strategy to reduce the percentage of patients with low risk BCC who receive a check-up at the dermatologist.
The project started with focus groups, interviews and discrete choice experiments with patients, dermatologists and general practitioners (GPs) on their motives and preferences for follow-up after a BCC. Based on these results, a personalized information letter is developed. The letter was already tested in three hospitals, and this was extended to nine hospitals. The difference in follow-up and patient satisfaction before and after the implementation of the letter was analysed. The goal was to reduce the number of follow-up appointments, while maintaining patient satisfaction.
A process evaluation was performed to identify what is necessary to implement the letter in daily practice and use it through the Netherlands. In addition, patients were interviewed to collect their experiences and improve the letter.
Dermatologists order low-value follow-up consults for patients that are treated for low-risk BCC, because they want to meet their patients’ wishes, have little faith in the GP to manage these follow-ups and experience a financial incentive. GP’s also experience several barriers, such as insufficient confidence in their own knowledge and skills, and lack of time and money. Patients that are treated for low-risk BCC have varying needs for follow-up, prefer seeing the dermatologist and need more and improved information.
There appear to be fewer follow-up visits using the personalized letter at the dermatologist compared to before the implementation of the letter. Patient satisfaction increased when they received the letter. Patients’ health is similar in the intervention and the control group. However, data is still being collected.
Dermatologists thought the personalized letter was a good addition to current BCC care, but for further use, the letter had to be easy to deliver. Dermatologists and patients agreed that the letter should be given to all new BCC patients.
At the moment, this project is being completed.
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