2015 Arte Poster Competition First Place Winner: Assessing the Correlation Between Patient Anxiety and Satisfaction for Mohs Surgery

In total, 17 patients required one Mohs layer to clear the carcinoma, and 19 required two or more. 72% of patients claimed the number of Mohs layers taken during the surgery had no effect on their anxiety level. However, all 8 patients (22%) who reported a decrease in anxiety due to the number of layers taken only required one layer (Figure 1).

Patients were asked about particular methods of distraction used on the day of surgery including engaging in small talk with the surgeon and staff; music playing during the procedure; activities done between layers such as sleeping, eating, reading, watching TV, and having a friend or family member (guest) present.

Of these, the most notable method that subjectively decreased anxiety on the day of surgery was engaging in small talk with surgeon and staff. Of the 29 patients who remembered doing this, 16 (55%) reported it decreased their anxiety.

Of the other distractors, bringing a guest, eating, and watching TV were also notable. 9 (60%) of those who brought a guest, 6 (67%) of those who ate, and 5 (42%) of those who watched TV experienced decreased anxiety.

31 patients (86%) reported a 10 for satisfaction with an average satisfaction overall of 9.81 (SD 0.57).

Skin cancer requiring the Mohs surgical technique is a potential source of anxiety for dermatology patients. Our results indicate that several important factors leading up to surgery and during the surgery experience have the potential to decrease a patient’s overall anxiety. Notably, 33% of surgical patients reported a decrease in anxiety from the time of diagnosis until the day of surgery. Factors that contributed to this included a call discussing the diagnosis and what to expect on the day of surgery as well as reading written material or searching the internet for more information regarding the procedure. Furthermore, a call from the physician compared to a call from a nurse or other team member showed a greater effect on decreasing anxiety. This suggests it might be beneficial to provide patients with written material, direct them to a website for accurate information, and have a physician discuss the diagnosis and procedure with them and answer their questions. Since not all patients will perceive decreased anxiety from any one of these, providing all of them to the patient for support may have the greatest impact on overall anxiety.

During the surgical procedure, our results highlight several factors that can decrease a patient’s anxiety. Most notably, eating, watching TV, bringing a guest, and engaging in small talk with surgeon and staff during the procedure subjectively decreased patients’ anxiety. While no particular distractor seemed to prevail over the others, providing a variety will likely reach the most patients. In addition, patients with only one layer taken to clear the carcinoma perceived a decreased anxiety level on average. Therefore, patients requiring 2 or more layers may be a group that will need more assistance managing their anxiety.

Patient satisfaction averaged 9.8 with most patients reporting a level of 10. Patients with higher anxiety did not report a lower satisfaction as hypothesized. We acknowledge that there are many factors that contribute to a patient’s overall satisfaction such as the facility space and interactions with the staff and surgeon. Therefore, a multi-center and multi-surgeon study would be ideal to further categorize the spectrum of patient satisfaction. Additionally, obtaining survey results in an anonymous fashion would encourage patients to answer in a manner more consistent with their true feelings rather than answering in a way that would seem pleasing to the interviewer.

In summary, our results suggest that patients respond to a variety of factors in terms of reducing anxiety and that each patient derives relief from anxiety in different manners. Therefore, offering a spectrum of comforting or distracting activities during the Mohs procedure is ideal and may reduce the need for pharmacologic anxiolytics. Making additional recommendations to patients prior to arriving for surgery such as bringing a friend or family member can be suggested for patients seeming anxious. It is also important to pay particular attention to the needs of patients who have not had Mohs surgery previously or who will have a longer procedure requiring more layers.