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Indian J Dermatol
Indian J Dermatol
IJD
Indian J Dermatol
Indian Journal of Dermatology
0019-5154
1998-3611
Wolters Kluwer - Medknow India

IJD-69-352
10.4103/ijd.ijd_816_23
Correspondences
Patient Satisfaction with a Skin Cancer Tele-Triage System in the North of England
Baptista Gonçalves Rui
Shah Manu 1
From the Dermatology Department, Northern Care Alliance, Salford Royal NHS Trust, Salford, United Kingdom E-mail: rui.baptistagoncalves@nhs.net
1 Department of Dermatology, East Lancashire Hospitals NHS Trust, Salford, United Kingdom
Jul-Aug 2024
19 8 2024
69 4 352353
8 2023
4 2024
Copyright: © 2024 Indian Journal of Dermatology
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcDear Editor,

Teledermatology has been gaining momentum, influenced by the reduction in trained dermatologists and rapid rise in skin cancer referrals, allied to the challenges imposed by the COVID-19 pandemic. Dermatology services in England receive around half-million two-week-wait (2WW) referrals every year, which is more than any other speciality.[1] Teledermatology has been implemented across the country, to ensure that patients referred under that pathway are seen timely and suitably followed up, albeit using different platforms and inconsistently audited.

As with any novel healthcare intervention, assessing patient satisfaction is essential to ensure service adherence and effectiveness. Most studies have reported a high degree of patient satisfaction with teledermatology services, albeit not usually focused on skin cancer or 2WW.[2] A recent London-based survey study was the first to assess patient satisfaction with a 2WW teledermatology service, and it found that most respondents would recommend the service, in particular those of better health status and of a younger age.[2]

Starting in the beginning of 2021, our center offers a tele-triage service, which is incorporated in the 2WW referral pathway. We use a proforma to direct low-risk patients to tele-triage and high-risk patients to a face-to-face appointment. The tele-triage service involves an initial appointment with the medical photographer who obtains clinical and dermatoscopic photographs of the relevant lesion(s), which are then, in conjunction with a completed paper medical questionnaire, virtually reviewed by a consultant dermatologist, who produces an outcome.

To assess the patient satisfaction with the current model, we have conducted a cross-sectional study of all patients referred to and reviewed by our tele-triage service between October 2022 and March 2023. We distributed a paper-based Likert-scale questionnaire, which was adapted from the London study,[2] assessing the clarity of information provided, experience of having photographs taken, impact on lifestyle, preferences of service provision, preference of electronic data collection, and overall assessment of the service. All patients attending this service were sent a copy of the questionnaire by post. If no response was returned within 2 weeks after postage, a repeat (and final) questionnaire was sent.

A total of 47 of 84 questionnaires were returned (response rate of 56%), and the sample was comprised of 53% females, with 85% aged 50 years or above. The large majority (96%) of patients found it comfortable having their photographs taken and agreed that the instructions were easy to follow (87%), had confidence that the dermatologist would be able to help by assessing the photos (75%) and agreed having received a quick response from the service after the initial appointment (92%). In terms of lifestyle impact, 68% agreed that this model saves time, compared with face-to-face appointments, with around half (47%) stating it allows them to lead a more flexible lifestyle and subsequently preferring to use a teledermatology service (47%), in contrast to 47% who would prefer to see a dermatologist in person. Similarly, 62% would rather have their full skin checked at the appointment, with 49% suggesting that they would rather have this service to take place at their GP practice. Around half would be happy to complete all documentation electronically. Overall, 72% would recommend the service, and all patients rated it a combined average score of 8.5 of 10.

When assessing the results by age group, those aged 55 years and older (n = 32) were more likely to prefer a face-to-face appointment (53% vs 33% for those younger than 55 years), felt that something was missing by not seeing a dermatologist (47% vs 13%), and reported lower confidence in the service (66% vs 93%). Despite this, in contrast to reports from other studies, a similar percentage of patients in both age groups would be happy to use electronically collected data (53% vs 56%). As for gender variations, women (53%) were less likely to prefer a face-to-face dermatology appointment (36% vs 59%), had greater confidence in the service (80% vs 68%), were less prone to consider that something was missing (16% vs 55%) and would recommend it more highly than men (84% vs 59%).

This cross-sectional study collected data at different times in each patient’s trajectory with the service, although always after the tele-triage had taken place, and it focused only on patients referred and reviewed by the tele-triage system, thus not generalisable to other similar teledermatology services. However, these results show a higher degree of satisfaction with the service when compared with previous studies.[234] Despite this, there are some nuanced variations that are worth noting: Although 92% consider the service to be quick and rate it 8.5/10, older patients would still prefer to see a dermatologist face-to-face, and thus may feel less confident with the system, corroborating previous studies.[2345] Although it was not assessed in this survey, patients’ reported quality of life and health status (often varying with age) may also influence these results.[5] These factors ought to be considered when setting up a teledermatology service: Although the existing formats may not be ideal for some, it is able to assess patients in a timely manner. In addition, reporting a greater acceptance to using electronic formats to collect data across our sample than in previous studies is a positive contribution to potential new developments in similar tele-triage services.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Ethics statement

All patients in this manuscript have given informed consent to participating in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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1 NHS England The two-week wait skin cancer pathway: Innovative approaches to support early diagnosis of skin cancer as part of the NHS COVID-19 recovery plan Available from: https://www.england.nhs.uk/wp-content/uploads/2022/04/B0829-suspected-skin-cancer-two-week-wait-pathway-optimisation-guidance.pdf [Last accessed on 2023 Aug 14]
2 Nicholson P Macedo C Fuller C Thomas L Patient satisfaction with a new skin cancer teledermatology service Clin Exp Dermatol 2020 45 691 8 32031275
3 Collins K Walters S Bowns I Patient satisfaction with teledermatology: Quantitative and qualitative results from a randomised controlled trial J Telemed Telecare 2004 10 29 33 15006213
4 Hunt WTN Ali L Marder H Sansom JE de Berker DAR A service evaluation between 2 week wait skin cancer referrals via teledermatology and the standard face-to face pathway at a teaching hospital Clin Exp Dermatol 2019 4 473 6
5 Williams TL Esmail A May CR Griffiths CE Shaw NT Fitzgerald D Patient satisfaction with teledermatology is related to perceived quality of life Br J Dermatol 2001 145 911 7 11899144
