Psychosocial Consequences of Diagnosed Malignant Melanoma

BACKGROUND: Psychosocial consequences frequently accompany the diagnosis of malignant melanoma (MM), such as fear, anxiety, burden, and distress. Patients are not receiving the proper psychiatric care needed to address the psychosocial consequences they are experiencing. Patients diagnosed with MM have expressed a lack of assessment and supportive care by providers to address psychosocial consequences they are experiencing.

LOCAL PROBLEM: The setting for the quality improvement project was a private dermatology clinic in Knoxville, Tennessee. There was no standard procedure for anxiety screening at the site. Comparable to published studies, there is a lack of procedures for screening patients for anxiety during routine follow-up visits. The purpose of this project was to implement a standardized anxiety screening tool with the aim of improving the psychosocial and emotional health of patients diagnosed with MM in a dermatologist office.

METHODS: The framework chosen to guide the project was the Evidence-based Practice Improvement (EBPI) model. The PDSA (Plan-Do-Study-Act) cycles developed the phases of implementation. The project utilizes engagement in small tests of change.

INTERVENTIONS: Use of the Generalized Anxiety Disorder screening tool (GAD-7) was implemented to screen all patients previously diagnosed with MM presenting to the clinic for routine follow- up visits. Patients scoring moderate to severe anxiety received a psychiatric referral.

RESULTS: Only 30% of participants reported mild-moderate anxiety. Forty percent of participants reported somewhat of difficulty when trying to work, take care of things at home, or get along with other people. 4 out of 10 participants reported current use of psychiatric medications.

CONCLUSIONS: The use of a standardized screening tool to assess anxiety in patients diagnosed with MM resulted in an increase in the identification and recognition of anxiety in patients at risk in this setting. Early identification of anxiety is a crucial first step in providing adequate patient care.