title: Patient satisfaction with GP-led melanoma follow-up: a randomised controlled trial.
abstract: BACKGROUND
  There are no universally accepted guidelines for the follow-up of individuals with cutaneous melanoma. Furthermore, to date, there have been no randomised controlled trials of different models of melanoma follow-up care. This randomised controlled trial was conducted to evaluate the effects of GP-led melanoma follow-up on patient satisfaction, follow-up guideline compliance, anxiety and depression, as well as health status.
  
  
  METHODS
  A randomised controlled trial of GP-led follow-up of cutaneous melanoma was conducted over a period of 1 year with assessment by self-completed questionnaires and review of general practice-held medical records at baseline and 12 months later. It took place in 35 general practices in North-east Scotland. Subjects were 142 individuals (51.4% women 48.6% men; mean (s.d.) age 59.2 (15.2) years previously treated for cutaneous melanoma and free of recurrent disease. The intervention consisted of protocol-driven melanoma reviews in primary care, conducted by trained GPs and supported by centralised recall, rapid access pathway to secondary care and a patient information booklet. The main outcome measure was patient satisfaction measured by questionnaire. Secondary outcomes were adherence to guidelines, health status measured by Short Form-36 and the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  There were significant improvements in 5 out of 15 aspects of patient satisfaction during the study year in those receiving GP-led melanoma follow-up (all P<or=0.01). The intervention group was significantly more satisfied with 7 out of 15 aspects of care at follow-up after adjustment for potential confounders. There was significantly greater adherence to guidelines in the intervention group during the study year. There was no significant difference in health status or anxiety and depression between intervention and control groups at either baseline or outcome.
  
  
  CONCLUSIONS
  GP-led follow-up is feasible, engenders greater satisfaction in those patients who receive it, permits closer adherence to guidelines and does not result in adverse effects on health status or anxiety and depression when compared with traditional hospital-based follow-up for melanoma.
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, UK. p.murchie@abdn.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Murchie
authors.forename: M C
authors.initials: MC
authors.lastname: Nicolson
authors.forename: P C
authors.initials: PC
authors.lastname: Hannaford
authors.forename: E A
authors.initials: EA
authors.lastname: Raja
authors.forename: A J
authors.initials: AJ
authors.lastname: Lee
authors.forename: N C
authors.initials: NC
authors.lastname: Campbell
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D012878:Skin Neoplasms / Q000175:diagnosis*
references.citation: Support Care Cancer. 2010 Feb;18(2):225-33
references.pmid: 19430819
references.citation: J Clin Oncol. 2006 Feb 20;24(6):848-55
references.pmid: 16418496
references.citation: J Health Serv Res Policy. 2004 Jul;9(3):159-64
references.pmid: 15272974
references.citation: Tumori. 1994 Jun 30;80(3):188-97
references.pmid: 8053075
references.citation: Br J Cancer. 2006 Apr 24;94(8):1116-21
references.pmid: 16622437
references.citation: Lancet Oncol. 2005 Aug;6(8):608-21
references.pmid: 16054572
references.citation: Cancer. 1999 Dec 1;86(11):2252-8
references.pmid: 10590365
references.citation: BMJ. 1996 Sep 14;313(7058):665-9
references.pmid: 8811760
references.citation: Psychooncology. 1998 Sep-Oct;7(5):436-9
references.pmid: 9809334
references.citation: Cancer Nurs. 2006 May-Jun;29(3):176-87
references.pmid: 16783116
references.citation: Eur J Surg Oncol. 2001 Sep;27(6):541-4
references.pmid: 11520086
references.citation: J Psychosom Res. 2002 Feb;52(2):69-77
references.pmid: 11832252
references.citation: Br J Plast Surg. 2005 Mar;58(2):245-50
references.pmid: 15710122
references.citation: Fam Pract. 1995 Mar;12(1):60-5
references.pmid: 7665044
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Mayo Clin Proc. 2001 Dec;76(12):1253-65
references.pmid: 11761506
references.citation: Stat Med. 2003 Aug 15;22(15):2417-28
references.pmid: 12872299
references.citation: Br J Dermatol. 2002 Jan;146(1):7-17
references.pmid: 11841361
references.citation: Fam Pract. 2003 Feb;20(1):83-92
references.pmid: 12509377
references.citation: Fam Pract. 2007 Jun;24(3):283-92
references.pmid: 17449893
references.citation: Br J Gen Pract. 1999 Sep;49(446):705-10
references.pmid: 10756611
references.citation: Ann Surg Oncol. 2009 Apr;16(4):941-7
references.pmid: 19101766
references.citation: Surg Gynecol Obstet. 1988 Jun;166(6):497-502
references.pmid: 3375961
references.citation: J Public Health Med. 1995 Mar;17(1):46-50
references.pmid: 7786567
references.citation: J Obstet Gynaecol. 2004 Feb;24(2):165-6
references.pmid: 14766455
references.citation: J Obstet Gynaecol. 1999 Mar;19(2):167-8
references.pmid: 15512262
references.citation: Am J Epidemiol. 1994 Aug 1;140(3):279-89; discussion 300-1
references.pmid: 8030631