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The Use of 3D-Printed Models to Optimize Patient Education and Alleviate Anxiety in Mohs Micrographic Surgery
TAKE-HOME MESSAGE
- In this study, 82 patients scheduled to undergo Mohs micrographic surgery (MMS) were randomized to standard education only (n=40) or to standard education plus a 3D-printed MMS model (n=42) to evaluate the impact of these interventions on perioperative anxiety. Both groups experienced significant reductions in anxiety scores measured using the visual analog scale (VAS) and significant increases in the understanding of the procedure. Patients in the 3D-printed MMS model group had greater reductions in VAS anxiety scores, approaching statistical significance (∆ = −1.31 vs ∆ = −.52; P=.052) as well as better understanding of the procedure (93.25% vs 85.83% correct responses in the 6-item knowledge assessment test; P<.028).
- As perioperative anxiety in MMS is associated with poor outcomes and patient dissatisfaction, improving the patient experience may be essential. This noninvasive, low-cost strategy may improve patient satisfaction and outcomes in MMS.
– InYoung Kim, MD, PhD
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Perioperative patient anxiety in Mohs micrographic surgery (MMS) is associated with increased postoperative pain and decreased satisfaction.
OBJECTIVE
Determine whether a 3D-printed (3DP) MMS model with standardized education (SE) improves perioperative patient understanding and anxiety.
METHODS
An unblinded, randomized controlled trial was conducted, with patients randomized into MMS model plus SE or SE alone groups. Baseline and post-stage understanding and anxiety were evaluated with the Visual Analog Scale (VAS) and State-Trait Anxiety Inventory (STAI). Additionally, patients completed a 6-item knowledge assessment.
RESULTS
Eighty-two patients were enrolled, 42 MMS model and 40 SE group, with similar group mean age, (67.8 years), gender (59.8% male), and previous MMS experience (47.6%). Both groups experienced significant reductions in VAS anxiety and STAI scores and significant increases in VAS understanding. Compared to SE alone, the MMS model group had larger VAS anxiety reduction approaching significance, Δ = -1.31, than SE group, Δ = -.52 (p = .052), 5.59 or 93.25% correct responses vs SE group 5.15 or 85.83% correct response (p<.028)."
LIMITATIONS
Overestimations of baseline patient anxiety in our population and 91.1% recruitment of the intended study population limited study power.
CONCLUSION
A 3DP MMS model with SE may improve patient understanding of MMS and decreases perioperative anxiety.
Additional Info
The Use of 3D-Printed Models to Optimize Patient Education and Alleviate Perioperative Anxiety in Mohs Micrographic Surgery: A Randomized Controlled Trial
J Am Acad Dermatol 2019 Jun 01;[EPub Ahead of Print], M Biro, I Kim, A Huynh, P Fu, M Mann, DL PopkinFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
One of our main roles as providers is to transmit complex information in an easily understandable manner to our patients. Mohs micrographic surgery (MMS) is no exception. In fact, MMS can be relatively challenging to conceptualize even for the educated. To address this, the cantaloupe and peanut butter cup analogies have been utilized as visualization tools to explain the procedure by Vassantachart et al and Lee et al, respectively.1,2 These are both great ideas, but can be a bit messy (albeit perhaps a nice snack!). They also don’t showcase the irregular “root(s)” of skin cancer responsible for the long Mohs days. And, of course, most importantly, they lack validation. Moreover, Sobanko et al pointed out that preoperative telephone consultation did not decrease patient anxiety before MMS, suggesting that, although still a potentially a good idea, it may only have benefit for a targeted demographic.3
In our study, patients randomized to receive preoperative education with the MMS 3D-printed model, in addition to the same standard-of-care structured verbal education, demonstrated a greater degree of understanding of MMS via a multiple-choice test format. In addition, we demonstrated decreased anxiety, which was almost certainly due to cognitive unloading. We tend to fear what we don’t understand. If patients can better understand the procedure, this would make the day go more smoothly and result in happier patients. Who wouldn’t want this in an anxiety-provoking situation, such as Mohs surgery?
Patient education prior to MMS is paramount. From personal experience, it is always enjoyable reaching for one of these models to better communicate with our patients. Now, you can print this 3D model, too, at your local library, university, or home 3D printer, as the data files have been made publicly available: click here. Try it for yourself!
References