One week after treatment for NMSC, patients were generally satisfied with their care, but were more satisfied with the interpersonal manners of the staff, with communication, and with financial aspects of their care, compared to the technical quality, time with the clinician, and accessibility of their care. Compared with those treated with destruction, patients treated with excision or Mohs were somewhat more likely to perceive better technical quality and communication, but the 4 other domains of short-term satisfaction were similar across treatment groups.
A year after treatment for NMSC, overall long-term satisfaction with therapy was high regardless of treatment type. Among patients treated with excision or Mohs, independent predictors of higher satisfaction were younger age, better pre-treatment skin-related quality of life, better pre-treatment mental health status, and treatment with Mohs surgery. Among patients treated with excision or destruction, the only independent predictor of higher satisfaction was better pre-treatment mental health status.
In all comparisons, better pre-treatment mental health predicted higher long-term satisfaction after treatment of NMSC. These results are consistent with a previous prospective study of dermatologic outpatients, which also showed that patient satisfaction measured at 3 days and 4 weeks after a dermatologic outpatient encounter was significantly associated with pre-visit quality of life and psychiatric disorders.9
Further evidence of the association of lower patient satisfaction with self-reported psychiatric morbidity is supported by a recently published review of the dermatologic literature.8
In the comparison of patients treated with excision or Mohs, the odds of higher satisfaction were less for older patients. This finding is in contrast to previous studies that have shown that older patients are more satisfied with their care,9,20
independent of health status. On the other hand, the relationship of age and satisfaction is likely complex.21
One possible explanation for our findings is that older patients may have been less tolerant of the length of the Mohs surgery procedure, although this issue deserves further study.
The finding that Mohs surgery was an independent predictor of higher satisfaction is potentially important. Studies of predictors of short-term and long-term satisfaction have found that short-term satisfaction is more likely associated with patient-doctor communication whereas long-term satisfaction is reflective of symptom outcome (symptom resolution, need for repeat visits, functional status).20
One possible explanation for better odds of higher long-term satisfaction following Mohs may be better functioning of local structures due to the tissue-sparing aspects of the technique. We have found no difference between patients treated with Mohs or excision, however, in long-term quality-of-life outcomes, including bother from appearance and effects on social or physical functioning.7
These findings may be due to the fact that quality of life and satisfaction reflect different aspects of patients’ experience after therapy.
The PSQ-18 may have lacked sensitivity by failing to inquire about key factors that are known to influence overall satisfaction, such as environmental factors, interactions between non-provider office staff and patient,22
and time spent in the waiting room.24-25, 26
Another limitation is that our study participants were patients willing to complete a questionnaire, which may limit generalizability. The 571 patients who responded about satisfaction at one year were similar to those who did not respond in many characteristics including age, gender, marital status, pretreatment physical and mental health, pretreatment Skindex scores, and tumor type and location of treatment, but had smaller tumors.
Although we have established statistically significant differences in the odds of higher satisfaction with certain patient and treatment characteristics, the clinical significance of these differences may be questioned. A previous study suggested that dermatology patients clearly differentiate between being satisfied or very satisfied with their healthcare.27
For some patients, being satisfied meant that aspects of their care could have been improved, whereas being very satisfied meant that optimal care had been provided. This finding suggests that subtle statistically significant differences in global satisfaction can have clinical relevance.
In summary, long-term patient satisfaction of treatment of NMSC is related to pre-treatment patient characteristics as well as treatment choice. These results need to be combined with data about other outcome measures to inform decision making for treatment of NMSC.