Abstract
Introduction
The incidence of newly diagnosed melanoma patients has significantly increased over the past few decades. In recent years, in addition to developing new diagnostic and preventive strategies, cancer centres have prioritized the establishment of highly specialised melanoma units (MUs), offering the implementation of an adequate follow-up plan, along with the evaluation of overall patient satisfaction and patient-reported outcome measures (PROMs).
Aim
The aim of this study was to evaluate the patient satisfaction of treatment and clinical care provided in multidisciplinary MUs.
Material and methods
The study was based on the analysis of results from a survey administered to all melanoma patients treated at the Lower Silesian Oncology, Pulmonology and Haematology Centre (LSOPHC) in Wroclaw. The questionnaire was a part of a pilot program for melanoma patients in the Lower Silesian Voivodeship (inhabited by approximately 2.9 million people).
Results
A total of 432 patients diagnosed with melanoma between May 2020 and February 2023 participated in the study. The study successfully gathered results concerning four key aspects outlined in the developed questionnaire: 1) infrastructure and organisation of treatment, 2) quality of medical care, 3) scope of information provided to patients, and 4) overall satisfaction with the pilot program.
Conclusions
Detailed questions in the survey yielded specific data highlighting both strengths and weaknesses of care provided to patients enrolled in the pilot program. The results of the patient satisfaction assessment may offer valuable insights for other MUs.
Keywords: melanoma, patient satisfaction, melanoma unit, follow-up, quality of life, survey
Introduction
Despite advances in diagnosis and the introduction of modern systemic therapies, melanoma – one of the cancers with a marked increase in newly diagnosed cases in recent decades [1] – remains one of the leading causes of cancer-related mortality worldwide [2]. This unfavourable trend persists despite the identification of several well-established factors influencing melanoma development, such as typical cellular mechanisms and genetic and molecular determinants. Additionally, various preventive initiatives and public health programmes have been implemented in recent years to combat the alarming progression of this challenging disease [3].
The management of melanoma has become a substantial challenge, not only for specialised oncology centres conducting clinical research but also for healthcare systems globally [4]. This challenge is largely driven by the significant financial burden associated with treatment, as well as the need for dedicated melanoma units (MUs) capable of delivering comprehensive, multidisciplinary care tailored to the diverse needs of this complex patient population [5, 6]. Nonetheless, oncological treatment strategies and the implementation of novel therapies must be balanced with a focus on patient-centred outcomes, particularly those related to quality of life [7]. Quality of life is widely recognised as a key determinant of successful outcomes in oncology, both in curative and palliative settings [8]. Several factors influence quality of life, including the minimisation of treatment-related burdens, individualisation of therapeutic strategies, provision of multidisciplinary care, creation of a supportive and comfortable treatment environment, delivery of optimal psychological support, transparent communication regarding the treatment process, and attention to patients’ social and overall well-being [9].
This dimension is especially important for melanoma patients, as supported by numerous systematic reviews that assess the impact of various therapeutic interventions on patient-reported outcomes [10]. In this context, patient overall satisfaction is a crucial aspect. It encompasses not only their satisfaction with the treatment itself but also with ancillary processes such as organisational aspects and living conditions, which are frequently overlooked in everyday clinical practice [11].
Factors influencing overall satisfaction (OS) include the coordination of medical services (e.g., registration and patient pathways), waiting times, competence of medical staff, quality of care provided by physicians and nurses, clarity of discharge instructions, and the integration of patient feedback into clinical decision-making [12].
An essential component of establishing cancer-specific treatment units is the integration of diverse treatment modalities alongside continuous patient education and the evaluation of patient satisfaction with the medical services provided [13]. However, there is a noticeable lack of publications addressing overall satisfaction among melanoma patients treated in highly specialised oncology units.
Aim
The aim of this study was to evaluate patient satisfaction during treatment and clinical care provided in a regional MU, with a focus on assessing the key determinants of overall satisfaction within this context.
Material and methods
The survey was administered to all melanoma patients treated at the Lower Silesian Oncology, Pulmonology, and Haematology Centre (LSOPHC). All subjects and/or their legal guardian(s) in this study gave informed consent. The survey was developed by a team of experts for this study and was approved by the Ethics Committee of the Wroclaw Medical University (Approval number: KB-477/22). It has not been previously published or used in any research. This study was a part of the pilot program implemented in the Lower Silesian Voivodeship (a south-western region of Poland with a population of approximately 2.9 million), although participation was voluntary. The pilot program, which began in May 2020, introduced several new initiatives, including pathological synoptic protocols, quality indicators, and the supervision of a medical coordinator [14].
At the outset, patients were asked to provide basic, non-identifiable demographic information and to indicate whether they had been hospitalized or received outpatient care. They were then asked to rate 34 aspects of their medical care experience at the MU, as outlined in Table 1. The survey covered three key areas: infrastructure and organisation of medical services (Part I), quality of medical care (Part II), and the scope of information provided to patients (Part III). The section on infrastructure and organisation (Part I) was completed only by patients who had been hospitalised. A 4-point scale was used to assess the importance of each aspect to the patient (1 = low priority, 4 = high priority), while a 5-point scale was employed to evaluate patient satisfaction with the implementation of each aspect (1 = very poor, 5 = very good).
Table 1.
Melanoma patient satisfaction assessment in the pilot program
| Area | Number | Aspect |
|---|---|---|
| I Infrastructure and organisation of treatment | Q1 | The quality of the meals |
| Q2 | Cleanliness of rooms | |
| Q3 | Accessibility of bathrooms with toilets | |
| Q4 | Cleanliness of bathrooms and toilets | |
| Q5 | Possibility of contact with the closest people/family and friends (visits, phone calls) | |
| Q6 | Adjusting the conditions in the department to the specificity of your cancer | |
| Q7 | Availability of the physician on duty when the attending physician is absent | |
| Q8 | Access to support from specialists: psycho-oncologist, clinical dietitian, physiotherapist, social worker | |
| Q9 | The nursing staff's response speed to patient calls | |
| II Quality of medical care | Q10 | Kindness and courtesy of the doctors in the department/clinic |
| Q11 | The interest of the attending physician in your health condition | |
| Q12 | Willingness of the attending physician to answer questions about your health condition | |
| Q13 | Accessibility (comprehensibility) of the information provided to you by the attending physician | |
| Q14 | Availability of the attending physician | |
| Q15 | Courtesy and friendliness of the nursing staff | |
| Q16 | The interest of the nursing staff in your health and well-being | |
| Q17 | The scope of information provided to you by the nursing staff on how to prepare for examinations/tests and treatments | |
| Q18 | Taking care to maintain your sense of intimacy during treatments and tests | |
| Q19 | Readiness of medical staff to help when you reported pain | |
| Q20 | Availability and accessibility of information provided by the cancer care coordinator | |
| III Scope of information provided to patients | Q21 | The information provided to you about your illness was sufficient |
| Q22 | There was no problem with access to interviews with doctors of various specialties (as part of the council) | |
| Q23 | Possible causes of illness are clearly communicated | |
| Q24 | Clear information was provided about the tests that should be performed | |
| Q25 | The information provided about the possible progression of the disease was clear | |
| Q26 | I was clearly informed about the stage of the disease (e.g. stages 1-4) | |
| Q27 | The information about the treatment plan was sufficient for you | |
| Q28 | Comprehensive information on possible therapies was provided | |
| Q29 | Clear information on the possible side effects of the therapy was provided | |
| Q30 | Specific expected results of the therapy were presented | |
| Q31 | You were kept informed about changes in the oncological treatment plan | |
| Q32 | You received information from the medical staff on how to proceed after leaving the oncology facility | |
| Q33 | Your family members (or carers) have been given effective emotional support | |
| Q34 | There was no problem with access to medical records | |
| IV Overall evaluation | Q35 | How do you assess the waiting time for health services provided under the pilot program? |
| Q36 | Was the consent for participation in the pilot program understandable? | |
| Q37 | If you have any doubts about the content of consent, was it explained to you? | |
| Q38 | Have you used the "oncology hotline" dedicated to oncological patients? | |
| Q39 | If "yes" – how do you evaluate the operation of the "oncology hotline"? | |
| Q40 | Did you receive support and help from the coordinator assigned to patients during the pilot program? |
At the conclusion of the survey, patients responded to six questions regarding their participation in the pilot program (Part IV). They were also asked: “If any of your family or friends required oncological treatment, would you recommend our hospital?” Responses to this question were rated on a 10-point scale, where 1 indicated “definitely not” and 10 indicated “definitely yes”.
Results
Demographic data
A total of 432 patients were enrolled in the study, of whom 221 (51.2%) were women diagnosed with melanoma between May 2020 and February 2023. Patients were divided into three age groups: under 45 years, 45 to 65 years, and over 65 years. There were 96 (22.2%) patients, 173 (40.0%) patients, and 163 (37.7%) patients in each group, respectively.
Regarding the place of residence, 93 (21.5%) patients reported living in rural areas, 201 (46.5%) patients in cities with populations of up to 150,000 inhabitants, and 138 patients (32.0%) in cities with populations over 150,000 inhabitants. In terms of treatment setting, the majority of patients were hospitalized (340 patients, 78.7%) and completed all sections of the survey. However, 92 (21.3%) patients were treated as outpatients and consequently did not complete all parts of the survey.
Infrastructure and organisation of treatment
The range of importance and satisfaction values for 9 aspects related to treatment organisation and infrastructure was 3.63–3.89, and 4.20–4.79, respectively. The mean response results are presented in Table 2. Patients considered Q9 (3.89 ±0.38), Q3 (3.87 ±0.37), and Q4 (3.87 ±0.36) as the most important for them. Conversely, Q1 (3.63 ±0.62) and Q8 (3.69 ±0.66) were considered the least significant. In terms of satisfaction, the highest mean scores were reported for Q9 (4.79 ±0.56) and Q2 (4.73 ±0.62), while the lowest satisfaction levels were observed for Q1 (4.20 ±0.97) and Q3 (4.36 ±0.97).
Table 2.
Results of patient assessment on infrastructure and treatment organisation
| Number | Aspect | Importance (mean ± SD) | Satisfaction (mean ± SD) |
|---|---|---|---|
| Q1 | The quality of the meals | 3.63 ±0.62 | 4.20 ±0.97 |
| Q2 | Cleanliness of rooms | 3.83 ±0.46 | 4.73 ±0.62 |
| Q3 | Accessibility of bathrooms with toilets | 3.87 ±0.37 | 4.36 ±0.97 |
| Q4 | Cleanliness of bathrooms and toilets | 3.87 ±0.36 | 4.59 ±0.74 |
| Q5 | Possibility of contact with the closest people/family and friends (visits, phone calls) | 3.76 ±0.63 | 4.39 ±1.03 |
| Q6 | Adjusting the conditions in the department to the specificity of your cancer | 3.85 ±0.43 | 4.62 ±0.67 |
| Q7 | Availability of the physician on duty when the attending physician is absent | 3.80 ±0.52 | 4.58 ±0.75 |
| Q8 | Access to support from specialists: psycho-oncologist, clinical dietitian, physiotherapist, social worker | 3.69 ±0.66 | 4.63 ±0.75 |
| Q9 | The nursing staff's response speed to patient calls | 3.89 ±0.38 | 4.79 ±0.56 |
Quality of medical care
In all aspects of the quality of medical care (Q10–Q20) the mean importance value was higher than 3.90, and reached 3.95 for Q11 (as shown in Table 3). The highest mean satisfaction value was observed in Q10 (4.82 ±0.51), and Q19 (4.81 ±0.54), while the lowest in Q14 (4.66 ±0.71) and Q11 (4.69 ±0.65).
Table 3.
Results of the quality of medical care assessment by surveyed patients
| Number | Aspect | Importance (mean ± SD) | Satisfaction (mean ± SD) |
|---|---|---|---|
| Q10 | Kindness and courtesy of the doctors in the department/clinic | 3.94 ±0.33 | 4.82 ±0.51 |
| Q11 | The interest of the attending physician in your health condition | 3.95 ±0.29 | 4.69 ±0.65 |
| Q12 | Willingness of the attending physician to answer questions about your health condition | 3.92 ±0.37 | 4.71 ±0.63 |
| Q13 | Accessibility (understandability) of information provided to you by the attending physician | 3.94 ±0.29 | 4.73 ±0.59 |
| Q14 | Availability of the attending physician | 3.91 ±0.40 | 4.66 ±0.71 |
| Q15 | Kindness and courtesy of the nursing staff | 3.92 ±0.31 | 4.76 ±0.55 |
| Q16 | The interest of the nursing staff in your health and well-being | 3.92 ±0.31 | 4.75 ±0.56 |
| Q17 | The scope of information provided to you by the nursing staff on how to prepare for examinations/tests and treatment | 3.94 ±0.29 | 4.77 ±0.56 |
| Q18 | Maintaining a sense of privacy during procedures/treatments and examinations | 3.92 ±0.37 | 4.76 ±0.62 |
| Q19 | Medical staff’s willingness to help when you reported pain | 3.94 ±0.29 | 4.81 ±0.54 |
| Q20 | Availability and accessibility of information provided by the oncology care coordinator | 3.93 ±0.34 | 4.73 ±0.65 |
Scope of information provided to patients
The mean values of importance of the scope of information provided to patients ranged from 3.73 to 3.92. The mean values of satisfaction in this area ranged from 4.31 to 4.67. Q21 and Q24 were rated as the most important with the mean value of 3.92 ±0.35, and 3.90 ±0.38, respectively (as shown in Table 4). In contrast, Q33 was rated as the least important with a mean value 3.73 ±0.72 (the only one below 3.80). Patients were most satisfied with Q24 (4.67 ±0.66) and Q34 (4.63 ±0.73), and least satisfied with Q33 (4.31 ±1.18), and Q23 (4.40 ±0.96).
Table 4.
Results of the scope of information provided to the surveyed patients
| Number | Aspect | Importance (mean ± SD) | Satisfaction (mean ± SD) |
|---|---|---|---|
| Q21 | The information provided to you about your illness was sufficient | 3.92 ±0.35 | 4.59 ±0.69 |
| Q22 | There was no problem with access to medical consultations of various specialties (within the council) | 3.84 ±0.47 | 4.51 ±0.80 |
| Q23 | Possible causes of illness are clearly communicated | 3.86 ±0.45 | 4.40 ±0.96 |
| Q24 | Clear information was provided about the tests that should be performed | 3.90 ±0.38 | 4.67 ±0.66 |
| Q25 | The information provided about the possible progression of the disease was clear | 3.88 ±0.43 | 4.53 ±0.84 |
| Q26 | I was clearly informed about the stage of the disease (e.g. stages 1-4) | 3.86 ±0.49 | 4.43 ±0.93 |
| Q27 | The information about the treatment plan was sufficient for you | 3.88 ±0.45 | 4.55 ±0.77 |
| Q28 | Comprehensive information on available therapies was provided | 3.87 ±0.45 | 4.47 ±0.92 |
| Q29 | Clear information on the possible side effects of the therapy was provided | 3.82 ±0.52 | 4.41 ±0.93 |
| Q30 | Specific expected results of the therapy were presented | 3.83 ±0.51 | 4.49 ±0.86 |
| Q31 | You were kept informed about changes in the oncological treatment plan | 3.84 ±0.51 | 4.59 ±0.73 |
| Q32 | You received information from the medical staff on how to proceed after leaving cancer center | 3.89 ±0.36 | 4.59 ±0.79 |
| Q33 | Your family members (or carers) have been given effective emotional support | 3.73 ±0.72 | 4.31 ±1.18 |
| Q34 | There was no problem with access to medical records | 3.86 ±0.45 | 4.63 ±0.73 |
Summary of the pilot program satisfaction
In the final section, patients evaluated various aspects of the melanoma pilot program. In response to question Q35 (“How do you assess the waiting time for health services provided under the pilot program?”), 243 (56.3%) patients considered the waiting time to be adequate, 96 (22.2%) patients found it unexpectedly short, and 83 (19.2%) patients deemed it too long or unsatisfactory. Regarding question Q36, which asked about the clarity of consent to participate in the pilot program, 16 (3.7%) patients indicated that they found the consent form unclear. Of these, 6 (1.4%) patients reported that their concerns were not addressed despite expressing doubts (Q37).
In question Q38, 207 (47.9%) patients stated that they used the dedicated “oncology hotline”. Of these, only 4 patients considered it ineffective, as indicated in question Q39. Furthermore, 409 (94.7%) patients affirmed that the designated coordinator provided assistance and support throughout the diagnostic and treatment process (Q40), with a mean satisfaction score of 9.40 ±1.2.
Discussion
The diagnosis and treatment of melanoma have undergone significant advancements over the past decade. Currently, melanoma treatment encompasses a wide array of therapeutic modalities, which are tailored to the disease stage. These range from surgical removal of the tumour, followed by scar excision with plastic reconstruction and concurrent sentinel lymph node biopsy or regional lymph node dissection, to the implementation of systemic regimens that include immunotherapy (anti-PD-L1/2) or various combinations of targeted therapies (iBRAF/iMEK) [15–17].
For some unresectable melanoma tumours, newer therapies such as electrochemotherapy or stereotactic photon radiotherapy are also utilised [18, 19].
As treatment approaches and regimens evolved, it became evident that melanoma care should be delivered in highly specialised Cancer Centres. These Centres must be equipped with a range of diagnostic tools and the capacity to offer all available treatment options, while ensuring that high-risk patients are subjected to long-term follow-up with the potential for immediate re-evaluation and re-treatment in the event of relapse or dissemination [20, 21].
Globally, MUs have begun to adopt an individual structure based on multidisciplinary teams, consisting mainly of dermatologists, plastic surgeons as well as surgical oncologists, radiotherapists and clinical oncologists [22]. To ensure efficient collaboration and to standardize team workflows, numerous studies and guidelines have been established to facilitate daily clinical practice [23]. Despite these significant developments, there remains a notable gap in universally established protocols for assessing patient satisfaction with melanoma care. A patient’s overall assessment, not only of the treatment process but also of the entire diagnostic and therapeutic journey, is often a crucial factor in optimizing therapeutic outcomes and enhancing the efficiency of care [24].
In this study, patient satisfaction regarding the treatment and clinical care provided in one reference melanoma centre in Wroclaw (Lower Silesian Voivodeship) was evaluated. The study was conducted on a representative sample of patients. The analysis utilized a survey developed as a part of a broader pilot program initiated for the MU. This survey, one of the first of its kind in Poland, allowed melanoma patients to evaluate the comprehensive medical care they received. It was designed according to standard research principles and methods used in similar studies [25, 26].
The satisfaction assessment was divided into four independent sections, enabling patients to thoroughly evaluate the hospital environment and express their needs. In the first section, which focused on infrastructure and treatment organisation, the highest ratings were given to the cleanliness of patient rooms and the responsiveness of nursing staff to patient calls. Both of these factors were found to meet the basic expectations of patients. Cleanliness was particularly emphasized, as it plays a key role in protecting patients from infections, which is crucial in the oncology setting [27]. Additionally, the prompt and always-available response of nursing staff to patient calls contributed significantly to the patients’ sense of safety and psychosocial support throughout their treatment and recovery [28]. On the other hand, the lowest satisfaction levels were observed in relation to the quality of meals and access to bathrooms with toilets. The dissatisfaction regarding meals likely stemmed from the dietary restrictions common in surgical wards, often necessitating bland or restricted diets, which patients typically found unappealing [29]. The lack of toilet facilities in some patient rooms was due to the historic nature of the building housing the surgical department, which was constructed at the turn of the 19th and 20th century.
The second section, which directly focused on aspects of medical care, revealed that patients were most satisfied with the courtesy and kindness of the doctors and the prompt response of medical staff to reported pain. Conversely, the lowest ratings were attributed to personal interactions with the attending physician. Interestingly, these ratings were complementary; patients generally expressed satisfaction with the quality of initial contact with their physician and appreciated their support in critical situations (e.g., pain management), but they expressed a desire for more frequent and extended interactions. This limited contact was primarily due to the global shortage of healthcare professionals and the particular nature of work in surgical wards, which often restricts the time available for patient-physician interactions [30].
The third analysed part of the survey, which addressed the scope of information provided to patients, showed that patients were most satisfied with clear information about scheduled examinations and easy access to their medical records. However, they expressed dissatisfaction with the emotional support provided by medical staff and with the information regarding the potential impact of melanoma on their overall health. These findings likely reflect the anxiety and uncertainty experienced by cancer patients, who often seek comprehensive and clear information about their prognosis and the impact of their condition on their well-being [31].
In the final section, which directly pertained to the pilot program itself, more than half of the respondents felt that the program provided adequate care in a timely manner. However, nearly the same proportion of patients reported that treatment was implemented either very quickly or too late. These mixed responses may be attributed to the heterogeneity of the sample, particularly with regard to the melanoma stage. Patients with early-stage melanoma might have been less concerned about potential delays in treatment than those with advanced disease [32].
The above analysis used a questionnaire prepared and developed specifically for the study (Supplementary 1).
A valuable direction for future research could be the expansion of the survey to include elements from Patient-Reported Outcome Measures (PROMs) [33]. The development of a new survey incorporating PROMs, along with the data gathered in this pilot study, could provide valuable insights into the objective assessment of the diagnostic, treatment, and hospital care processes for melanoma patients.
Conclusions
Following this research project, a clear assessment of satisfaction with the diagnostic process, treatment and medical care among melanoma patients was obtained. This study assessed elements related to perceptions of medical care at both psychosocial and clinical levels. The pilot program clearly showed a high level of satisfaction among patients treated in the specialised MU. In each of the analysed sections of the program, significant issues reported by patients were identified, highlighting areas that require immediate attention and improvement.
These findings offer valuable insights that could help enhance the quality of care and patient satisfaction in other MUs. However, the authors acknowledge that the results are subject to certain limitations, as they are based on a selected group of patients treated at a single regional Cancer Centre. This may influence the evaluation of specific parameters within the survey.
Funding Statement
Funding This research was financed through statutory subsidies by the Ministry of Health as part of the Department of Oncology Wroclaw Medical University research grant SUBZ.C280.25.016 (record number in the Simple System).
Ethical approval
All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects and/or their legal guardian(s). The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Wroclaw Medical University (Approval number: KB-477/22).
Conflict of interest
The authors declare no conflict of interest.
References
- 1.Ziętek M, Nowacki M, Wierzbicki J, et al. An analysis of clinical effectiveness of electrochemotherapy in the treatment of advanced metastatic malignant melanoma performed in the eastern part of Central Europe: a single-centre experience. Adv Dermatol Allergol 2022; 39: 559-64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Abbas O, Miller DD, Bhawan J. Cutaneous malignant melanoma: update on diagnostic and prognostic biomarkers. Am J Dermatopathol 2014; 36: 363-79. [DOI] [PubMed] [Google Scholar]
- 3.Zegarska B, Pietkun K, Zegarski W, et al. Air pollution, UV irradiation and skin carcinogenesis: what we know, where we stand and what is likely to happen in the future? Adv Dermatol Allergol 2017; 34: 6-14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kandel M, Bardet A, Dalle S, et al. Cost-effectiveness analysis of sequential treatment strategies for advanced melanoma in real life in France. Curr Oncol 2022; 29: 9255-70. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Johnston KM, McPherson E, Osenenko K, et al. Cost-effectiveness of therapies for melanoma. Expert Rev Pharmacoecon Outcomes Res 2015; 15: 229-42. [DOI] [PubMed] [Google Scholar]
- 6.Dorrell DN, Strowd LC. Skin cancer detection technology. Dermatol Clin 2019; 37: 527-36. [DOI] [PubMed] [Google Scholar]
- 7.Nowacki M, Alyami M, Villeneuve L, et al. Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: an international survey study. Eur J Surg Oncol 2018; 44: 991-6. [DOI] [PubMed] [Google Scholar]
- 8.Drageset J, Sandvik RK, Eide LSP, et al. Quality of life among cancer inpatients 80 years and older: a systematic review. Health Qual Life Outcomes 2021; 19: 98. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Suarez-Almazor M, Pinnix C, Bhoo-Pathy N, et al. Quality of life in cancer care. Medicine 2021; 2: 885-8. [DOI] [PubMed] [Google Scholar]
- 10.Malkhasyan KA, Zakharia Y, Milhem M. Quality-of-life outcomes in patients with advanced melanoma: a review of the literature. Pigment Cell Melanoma Res 2017; 30: 511-20. [DOI] [PubMed] [Google Scholar]
- 11.Berning V, Heidegger T, Laupheimer M, Nübling M. Patient satisfaction and quality of recovery. Anaesthesia 2018; 73: 521-2. [DOI] [PubMed] [Google Scholar]
- 12.Gavurova B, Dvorsky J, Popesko B. Patient satisfaction determinants of inpatient healthcare. Int J Environ Res Public Health 2021; 18: 11337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Nowacki M, Zegarski W. The scientific report from the first pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures performed in the eastern part of Central Europe. J Int Med Res 2018; 46: 3748-58. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ziętek M, Wierzbicki J, Pawlak E, et al. Introduction of a pilot program to measure and improve the clinical care of melanoma patientsf in the Lower Silesian Voivodeship in Poland: a report of 20 months experience. BMC Cancer 2022; 22: 1207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ziętek M, Zdzienicki M, Wierzbicki J, et al. Survival of patients with stage IIIC and IIID melanomas with nodal metastases in the light of new therapies. Adv Dermatol Alergoll 2022; 39: 1141-50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Jenkins RW, Fisher DE. Treatment of advanced melanoma in 2020 and beyond. J Invest Dermatol 2021; 141: 23-31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Long-term outcomes with nivolumab plus ipilimumab or nivolumab alone versus ipilimumab in patients with advanced melanoma. J Clin Oncol 2022; 40: 127-37. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Eibenberger K, Dunavoelgyi R, Gleiss A, et al. Hypofractionated stereotactic photon radiotherapy of choroidal melanoma: 20-year experience . Acta Oncol 2021; 60: 207-14. [DOI] [PubMed] [Google Scholar]
- 19.Cucu CI, Giurcăneanu C, Popa LG, et al. Electrochemotherapy and other clinical applications of electroporation for the targeted therapy of metastatic melanoma. Materials 2021; 14: 3985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 1: diagnostics: update 2022. Eur J Cancer 2022; 170: 236-55. [DOI] [PubMed] [Google Scholar]
- 21.Atkins MB, Curiel-Lewandrowski C, Fisher DE, et al. The state of melanoma: emergent challenges and opportunities. Clin Cancer Res 2021; 27: 2678-97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: treatment - update 2022. Eur J Cancer 2022; 170: 256-84. [DOI] [PubMed] [Google Scholar]
- 23.Nakamura Y, Asai J, Igaki H, et al. Japanese Dermatological Association guidelines: outlines of guidelines for cutaneous melanoma 2019. J Dermatol 2020; 47: 89-103. [DOI] [PubMed] [Google Scholar]
- 24.Morawik I, Gospodarek M, Turżańska K, et al. The role of the perioperative nursing care in the satisfaction of patients after large joint replacements. Wiad Lek 2020; 73: 1824-8. [PubMed] [Google Scholar]
- 25.Thayaparan AJ, Mahdi E. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online 2013; 18: 21747. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Liang H, Xue Y, Zhang ZR. Patient satisfaction in China: a national survey of inpatients and outpatients. BMJ Open 2021; 11: e049570. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013; 26: 338-44. [DOI] [PubMed] [Google Scholar]
- 28.Mohammmed Iddrisu S, Hutchinson AF, Sungkar Y, Considine J. Nurses’ role in recognising and responding to clinical deterioration in surgical patients. J Clin Nurs 2018; 27: 1920-30. [DOI] [PubMed] [Google Scholar]
- 29.Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017; 36: 623-50. [DOI] [PubMed] [Google Scholar]
- 30.Lorkowski J, Jugowicz A. Shortage of physicians: a critical review. Adv Exp Med Biol 2021; 1324: 57-62. [DOI] [PubMed] [Google Scholar]
- 31.Lang-Rollin I, Berberich G. Psycho-oncology. Dialogues Clin Neurosci 2018; 20: 13-22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Zafar SY, Alexander SC, Weinfurt KP, et al. Decision making and quality of life in the treatment of cancer: a review. Support Care Cancer 2009; 17: 117-27. [DOI] [PubMed] [Google Scholar]
- 33.Di Maio M, Basch E, Denis F, et al. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33: 878-92. [DOI] [PubMed] [Google Scholar]