Surgery or Non-invasive Treatment for Superficial Basal Cell Carcinoma: Does a Patient Decision Aid Help to Make a Personalized Treatment Decision?
DOI:
https://doi.org/10.2340/actadv.v105.41914Keywords:
basal cell carcinoma, decision-making, shared, decision support techniquesAbstract
Patients with a superficial basal cell carcinoma can be treated surgically or non-invasively, all with specific (dis)advantages. An investigation was undertaken into whether the preference for surgery or non-invasive treatment of a superficial basal cell carcinoma differs between patients who used a patient decision aid and a control group. Secondly, whether patients were satisfied with their decision post-treatment was investigated. A prospective observational study was performed comparing patients with a superficial basal cell carcinoma who used a patient decision aid (patient decision aid group) with a control group. The primary outcome was the proportion of patients that chose non-invasive treatment. A secondary outcome was the mean score of “effective decision-making” on the Decisional Conflict Scale 3 months post-treatment. In the patient decision aid group, 48.6% (52/109) seemed to prefer non-invasive treatment vs 40.8% (42/103) in the control group (p = 0.255); the result was not significant. Three months post-treatment, the adjusted between-group mean difference in “effective decision-making” was –4.10 (p = 0.082) favouring the patient decision aid group (effect size 0.3). To conclude, patients who used a patient decision aid seemed to choose non-invasive therapy over surgery slightly more often but the result was not significant.
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References
Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78: 540–559.
https://doi.org/10.1016/j.jaad.2017.10.006 DOI: https://doi.org/10.1016/j.jaad.2017.10.006
Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, et al. Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. Eur J Cancer 2019; 118: 10–34.
https://doi.org/10.1016/j.ejca.2019.06.003 DOI: https://doi.org/10.1016/j.ejca.2019.06.003
Neal DE, Feit EM, Etzkorn JR. Patient preferences for
the treatment of basal cell carcinoma: a mapping review of discrete choice experiments. Dermatol Surg 2018; 44:
1041–1049.
https://doi.org/10.1097/DSS.0000000000001564 DOI: https://doi.org/10.1097/DSS.0000000000001564
Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4: CD001431.
https://doi.org/10.1002/14651858.CD001431.pub5 DOI: https://doi.org/10.1002/14651858.CD001431.pub5
van Delft LCJ, Essers BAB, Nelemans PJ, Mosterd K, Kelleners-Smeets NWJ. Development of a patient decision aid for superficial basal cell carcinoma. Br J Dermatol 2021; 184: 744–746.
https://doi.org/10.1111/bjd.19662 DOI: https://doi.org/10.1111/bjd.19662
van Delft LCJ, Essers BAB, Nelemans PJ, Mosterd K, van Winden MEC, Romaen IFL, et al. Effectiveness of a patient decision aid for patients with superficial basal cell carcinoma: a pre- and post-implementation study. Patient Educ Couns 2023; 115: 107907.
https://doi.org/10.1016/j.pec.2023.107907 DOI: https://doi.org/10.1016/j.pec.2023.107907
Tan J, Linos E, Sendelweck MA, van Zuuren EJ, Ersser S, Dellavalle RP, et al. Shared decision making and patient decision aids in dermatology. Br J Dermatol 2016; 175: 1045–1048.
https://doi.org/10.1111/bjd.14803 DOI: https://doi.org/10.1111/bjd.14803
Tan J, Wolfe B. Improved decisional conflict and preparedness for decision making using a patient decision aid for treatment selection in psoriasis: a pilot study. J Cutan Med Surg 2014; 18: 114–118.
https://doi.org/10.2310/7750.2013.13113 DOI: https://doi.org/10.2310/7750.2013.13113
Arits AH, Mosterd K, Essers BA, Spoorenberg E, Sommer A, De Rooij MJ, et al. Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial. Lancet Oncol 2013; 14: 647–654.
https://doi.org/10.1016/S1470-2045(13)70143-8 DOI: https://doi.org/10.1016/S1470-2045(13)70143-8
Bath-Hextall F, Ozolins M, Armstrong SJ, Colver GB, Perkins W, Miller PS, et al. Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15: 96–105.
https://doi.org/10.1016/S1470-2045(13)70530-8 DOI: https://doi.org/10.1016/S1470-2045(13)70530-8
Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma: abridged Cochrane systematic review and GRADE assessments. Br J Dermatol 2021; 185: 499–511.
https://doi.org/10.1111/bjd.19809 DOI: https://doi.org/10.1111/bjd.19809
Verkouteren JAC, Ramdas KHR, Wakkee M, Nijsten T. Epidemiology of basal cell carcinoma: scholarly review. Br J Dermatol 2017; 177: 359–372.
https://doi.org/10.1111/bjd.15321 DOI: https://doi.org/10.1111/bjd.15321
Koedoot N, Molenaar S, Oosterveld P, Bakker P, de Graeff A, Nooy M, et al. The decisional conflict scale: further validation in two samples of Dutch oncology patients. Patient Educ Couns 2001; 45: 187–193.
https://doi.org/10.1016/S0738-3991(01)00120-3 DOI: https://doi.org/10.1016/S0738-3991(01)00120-3
O’Connor A. User manual: Decisional Conflict Scale 2010. Available from: https://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_decisional_conflict.pdf
Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res 2010; 19: 887–897.
https://doi.org/10.1007/s11136-010-9649-x DOI: https://doi.org/10.1007/s11136-010-9649-x
Hoefel L, Lewis KB, O’Connor A, Stacey D. 20th Anniversary Update of the Ottawa Decision Support Framework: Part 2 Subanalysis of a systematic review of patient decision aids. Med Decis Making 2020; 40: 522–539.
https://doi.org/10.1177/0272989X20924645 DOI: https://doi.org/10.1177/0272989X20924645
Aymonier M, Taieb C, Corgibet F, Joly P, Sei JF, Chaussade V, et al. Patient perception of the diagnosis announcement and its impact on quality of life of patients with primary melanoma or basal cell carcinoma. Acta Derm Venereol 2022; 102: adv00717.
https://doi.org/10.2340/actadv.v102.2217 DOI: https://doi.org/10.2340/actadv.v102.2217
Khoshab N, Vaidya TS, Dusza S, Nehal KS, Lee EH. Factors contributing to cancer worry in the skin cancer population. J Am Acad Dermatol 2020; 83: 626–628.
https://doi.org/10.1016/j.jaad.2019.09.068 DOI: https://doi.org/10.1016/j.jaad.2019.09.068
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Copyright (c) 2025 Lieke C.J. van Delft, Myrthe M.G. Moermans, Brigitte A.B. Essers, Patty J. Nelemans, Klara Mosterd, Marieke E.C. van Winden, Satish F.K. Lubeek, Nicole W.J. Kelleners-Smeets

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