Skin Lesions Made Easy: A Case Study on Using Participatory Approaches to include Patients, Clinicians, and Members of the Public to Improve Dermatology Referrals

Problem

Neoplastic skin lesions often require a dermatology referral to rule out malignancy or arrange treatment. The initial reviews of these cases are performed in a primary care setting. General practitioners (GPs) often triage cases, determine urgency and collect pertinent information for specialist assessment and referral.

There is a risk of information loss at this step, and it has been shown that the quality of skin cancer referrals is often suboptimal (The King’s Fund 2010, NHS England 2022), resulting in duplication of work as dermatology departments repeat the information gathering process. Our aim is to improve the quality of referrals through increased patient engagement in order to facilitate high-quality, high-throughput dermatology reviews without increasing primary care workload. This work was conducted as part of a larger research activity to improve the management of skin lesions that require dermatology review.

Approach

A teledermatology questionnaire (TDQ) was developed in partnership with our Public and Patient Involvement and Engagement committee formed by 4 lay members and consultant dermatologists. The aim was to improve the quality of referrals without introducing additional burden to the GP workload. The TDQ was developed with a qualitative participatory approach, which included the collection of clinical and demographic data to reach a decision on lesion management. Feedback from four patients and members of the public was collected through questionnaires and focus groups. Qualitative data analysis was performed in accordance with the six phases for thematic analysis suggested by Braun and Clarke 2006. The TDQ was implemented in a teledermatology service, and patients were asked to complete a further questionnaire on their experience in completing the form and the teledermatology service in general.

Findings

The TDQ was modified in response to an iterative feedback cycle. Various questions were rephrased and educational material was developed, in partnership with patients, and added to explain two questions. 99% of patients completed the TDQ prior to their teledermatology appointment. 90 out of 101 patients felt that the TDQ was easy to complete.

Consequences

Including multiple stakeholders in the development of a means to supplement a GP referral resulted in a questionnaire that was accepted and used by the vast majority of patients. The questionnaire received positive reception and was widely used by patients. This illustrates the vital role of public and patient involvement and engagement in improving the quality of research and clinical referrals.