title: Psychological distress surrounding diagnosis of malignant and nonmalignant skin lesions at a pigmented lesion clinic.
abstract: This study aimed prospectively to investigate psychological distress throughout the diagnostic process in an outpatient pigmented lesion clinic (PLC). Psychological distress was measured at pre clinical diagnosis, post clinical diagnosis, pre histological diagnosis (including a benign follow-up) and post histological diagnosis stages using standard anxiety measurement scales and a study specific measure of satisfaction with care. In total 324 patients undergoing investigation of a suspicious skin lesion consented to take part out of a cohort of 463 patients who attended the PLC in a 6 month period. Using recognised cut-off scores, 27% of women on clinic arrival reported clinically high levels of anxiety, in comparison with 10% of men (p < 0.0001). Patients given an immediate benign post clinical diagnosis reported a reduction in anxiety (p < 0.0001) but patients requiring a biopsy reported elevated levels of anxiety. Approximately, 30% of these biopsy patients reported clinically high levels of anxiety both before and after diagnosis. Patients who received a post histological diagnosis of malignant melanoma also reported the pre histological stage at the clinic as more distressing than waiting for and receiving results (p < 0.01). Patient's quality of life prior to diagnosis was excellent, but emotional functioning (p < 0.05), insomnia (p<or=0.001), and global health status (p<or=0.001) deteriorated throughout the diagnostic process for those patients who were finally diagnosed as having malignant melanoma. Patients reported high levels of satisfaction with clinic attendance and treatment, regardless of diagnosis but a need for further information was identified. This study has implications for all healthcare professionals involved in the provision of care through Pigmented Lesion Clinics in UK. The diagnostic process of a suspicious lesion is evidently a 'critical' stage requiring appropriate provision of care to meet patients' psychosocial and information needs if distress is to minimised for the large numbers of patients attending a PLC each year.
authors.affiliation: Bristol Clinical Psychology Doctorate, Bristol University, 29 Park Row, Clifton, Bristol BS1 5NB, UK. fshas@bristol.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Al-Shakhli
authors.forename: D
authors.initials: D
authors.lastname: Harcourt
authors.forename: J
authors.initials: J
authors.lastname: Kenealy
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001706:Biopsy / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012878:Skin Neoplasms / Q000175:diagnosis / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*