key: cord-0831776-bisgaab4
authors: Nicholson, P.; Ali, F.R.; Patalay, R.; Craythorne, E.; Mallipeddi, R.
title: Patient perceptions of Mohs micrographic surgery during the COVID‐19 pandemic and lessons for the next outbreak
date: 2020-08-16
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14423
sha: 2ec81f888fde5fe56474efa55cd9e516cd5ef175
doc_id: 831776
cord_uid: bisgaab4

Understanding patient experiences of healthcare systems during the pandemic is important to help strategize for future similar events. We operated a reduced Mohs micrographic surgery (MMS) service during the pandemic through rationalising patients by tumour type, age, co‐morbidities and patient choice. We sought to establish patient expectations and concerns of attending MMS by conducting a survey of those attending surgery over a 7‐week period from 24(th) April 2020. The results are particularly relevant when re‐establishing services in preparation for an expected upsurge of routine activity (including surgical procedures) or ‘second spike’ of COVID‐19 cases later this year.

Understanding patient experiences of healthcare systems during the pandemic is important to help strategize for future similar events. We operated a reduced Mohs micrographic surgery (MMS) service during the pandemic through rationalising patients by tumour type, age, comorbidities and patient choice. We sought to establish patient expectations and concerns of attending MMS by conducting a survey of those attending surgery over a 7-week period from 24 th April 2020. The results are particularly relevant when re-establishing services in preparation for an expected upsurge of routine activity (including surgical procedures) or 'second spike' of COVID-19 cases later this year.

Whilst patients who may not have attended surgery were not surveyed, 37% of patients had at least one risk factor for COVID-19 and 27% were over 70 years old. Furthermore, we also have a high response rate of 96% (151 responses) reflecting an accurate representation of patient experiences. 52% were male and 48% female; and the majority (98%) Caucasian. The age range was 30-89 years and the majority (91%) described their health status as good to excellent.

Our main findings were that the overwhelming majority of patients (82%) were relieved to have surgery. 47% were worried the hospital would cancel their surgery. Only 17% considered cancelling due to concerns about contracting coronavirus; transmitting to household/ family members; and taking public transport. 54% were anxious about using public transport to attend their appointment. An overwhelming majority (80%) stated they would have normally used public transport (if there was not an ongoing pandemic) while only 45% actually did.

Less than a quarter were concerned they would contract COVID-19 in hospital and 30% about transmitting to household/ family members. Only 19% were concerned about the ability to social distance in hospital. Despite these concerns, patients still attended for MMS. This is the first study exploring patient perceptions of MMS during the pandemic. Patients overwhelmingly appreciated having MMS treatment in a safe environment. There were some COVID-19 related concerns, however patients felt that attending their appointment was more important. Relatively few patients were concerned about being able to socially distance in hospital; this may reflect our strong infection control measures 1 and effective communication including a nurse-led consultation prior to the appointment. During this consultation patients are given information about infection control measures and have the opportunity to ask questions.

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The main limitation is we surveyed patients who attended hospital for surgery, although a third of patients had COVID-19 risk factors and over a quarter were over 70 years old.

In conclusion, it is clear patients strongly appreciate continued MMS services during the pandemic and continuation of surgery helps reduce treatment delays and backlogs. Our key lessons for any future pandemic or second wave are that MMS services should continue to run with patients prioritised based on clinical judgement and limiting risks. Effective patient communication is vital prior to surgery to prepare patients and alleviate their concerns. Finally, it is important that multiple infection control measures are implemented to reduce transmission.

We can and should strive to continue to deliver high quality care and reduce associated risks to provide the best outcomes for patients. This will be critical in any second wave or future pandemics.

Impact of COVID-19 on Mohs micrographic surgery: UKwide survey and recommendations for practice