Assessing patient satisfaction at a medical student-organized free community skin cancer screening

Abstract

Introduction

Skin cancer screening is a safe and simple screening test in medicine. To provide skin cancer screenings for the Kansas City (KC) metropolitan area, students from local medical schools collaborated with dermatologists to organize the first annual collaborative skin cancer screening event.

Methods

To assess patient satisfaction and barriers to dermatologic care, participants completed a survey, which included multiple-choice questions addressing demographics, access to dermatologic care, and event satisfaction. Statistical significance was determined using Fisher’s Exact and chi-square tests.

Results

A total of 48 screenings were performed and 46 attendees participated in the study. The majority of participants were female (61%), White (65%), English-speaking (80%), with at least a bachelor’s degree (72%) and health insurance (78%). Most participants had not been seen for a skin concern in the past year (70%) and had never attended a community screening event (89%). Many participants (50%) stated they would not have had an annual skin check without the event. Participants were largely satisfied with the event, and most reported being very likely to attend again. Race was associated with prior attendance at a screening event (p = 0.045) and reporting cost (p = 0.0099) or lack of insurance (p = 0.0016) as barriers to care. Younger age was associated with first-time screening attendance (p = 0.004).

Discussion

Despite being free and open to the public, the event primarily attracted groups not traditionally underserved. These findings support ongoing efforts to expand community-based screening initiatives in the KC area.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s41043-026-01405-8.

Introduction/Background

Skin cancer remains the most common malignancy globally, affecting millions of individuals each year; however, its prognosis improves markedly when identified and treated early [1, 2]. The total-body skin exam is a safe, noninvasive, and accessible screening tool and can be completed in just a few minutes by trained clinicians [2]. Structured skin screening programs have the potential to substantially reduce morbidity, mortality, and long-term healthcare costs by identifying lesions at earlier, more treatable stages [2]. Garbe et al. [1] similarly emphasize that preventive screening and patient education remain the cornerstone of reducing skin cancer burden. The evidence for structured full-body skin cancer screening programs shows mixed results, with the United States Preventive Services Task Force concluding there is insufficient evidence to recommend for or against routine population-based screening [3].

Several free and community-based skin cancer screening initiatives have documented tangible benefits. In one large study consisting of 180 patients, 246 biopsies were performed and malignancy was detected in approximately 27% of the biopsied lesions, highlighting the benefit of early skin cancer screening [4]. In another review, Young et al. found that free screening events often reach patients who would not otherwise access dermatologic care, and a substantial proportion (54%) represent individuals who would not have pursued evaluation independently [5, 6].

In order to expand access to dermatologic care within the Kansas City (KC) metropolitan area, students from The University of Kansas School of Medicine, Kansas City University College of Osteopathic Medicine, and the University of Missouri–Kansas City School of Medicine partnered with local dermatologists to launch the first annual collaborative community skin cancer screening event in KC. This study was designed to assess participant satisfaction and barriers to dermatologic care.

Materials and methods

A cross-sectional survey was distributed at a single-day community skin cancer screening event at JayDoc Free Clinic in Kansas City, Kansas. The survey was developed through iterative revisions among the study team and piloted with non-participant local community members to ensure accuracy and comprehension. The survey was primarily designed to inquire about patient demographics and behaviors towards free clinics and skin cancer screenings. Criteria for study inclusion were participants over the age of 18. The survey was only offered in English so participants also had to be proficient in the language. Participants were asked to complete the survey after their skin cancer screening to ensure that their decision to participate did not influence, or appear to influence, the quality of their care.

Prior to the event, numerous methods of advertising were used to alert the public of the opportunity. The event was advertised as accepting appointments to guarantee a spot as well as accepting walk-ins. The University of Kansas Medical Center promoted the event with multiple social media posts. The event was also shared on local news networks and radio shows, as well as with each participating medical school’s student body. Event organizers left hundreds of flyers in businesses, schools, and churches both in areas directly around the event and in neighboring areas. Flyers were only created in English. Event organizers also communicated directly with patients at the JayDoc Free Clinic, calling patients who had been seen the past nine years in the dermatology clinic, a time period determined by our furthest records of patient phone numbers, to see if they would like to be scheduled for a free screening. These phone calls were conducted in English and Spanish using the certified translators available to the clinic.

Medical students were responsible for all aspects of the event planning and production. Medical students received guidance from Masonic Cancer Allianace associated with the The University of Kansas Medical Center on advertising, record-keeping, and forms to ensure the event followed regulations. Physicians performed the screenings alongside a medical student who took a preliminary history from each participant and recorded any findings from the physician. A variety of skin exams were offered to patients, including full-body, waist-up, and specific lesion exams. All exams were completed using dermoscopy. All paperwork was completed by students and reviewed by physicians for record-keeping. Students also collaborated with the Masonic Cancer Alliance to create a plan for any lesions that needed additional work-up following the event, creating options for participants with and without health insurance.

Surveys were completed on paper, and study members entered responses into REDCap for analysis. Completion time for the survey took less than five minutes for the majority of participants. The questions included 5-point Likert Scales, multiple-choice and fill-in-the-blank and assessed participant demographics (gender, age, race, language, education, and health insurance status), ability to access dermatologic services, and event satisfaction.

The University of Kansas Medical Center Institutional Review Board approved the study (STUDY00161951). Participants signed a consent form which included the purpose of the study and intended results. Participants were also given a copy of the consent form for their records. Results were analyzed via REDCap generated data viewing. Categorical variables were compared using chi-square tests when expected cell counts met standard assumptions. Fisher’s Exact tests were used when expected cell counts were small or when sparse data limited the reliability of c.

chi-square testing. To calculate statistical significance of results, race was categorized as White and Non-white. This decision was due to several racial subgroups that contained very small sample sizes that would have limited the validity of statistical testing. Likewise, age was grouped into three categories: 20–40 years, 41–60 years, and 61–85 years. Given the exploratory nature of the analysis, adjustments for multiple comparisons were not applied. A significance threshold of p < 0.05 was used.

Results

A total of 46 surveys were completed from 48 participants (96% participation rate). The two attendees who did not participate both spoke English and, therefore, the survey only being in English did not affect the number of participants in this study. The majority of participants were female (n = 28, 61%), white (n = 30, 65%), English-speaking (n = 37, 80%), with at least a bachelor’s degree (n = 33, 72%) and health insurance (n = 36, 78%). The average age of participants was 41 years. Demographics of participants can be found in Table 1.

Table 1.

Demographics of survey participants

Gender	Count (Percent)
Male	18 (39%)
Female	28 (61%)
Age
20–40 years	26 (57%)
41–60 years	14 (30%)
61–85 years	6 (13%)
Race
White	30 (65%)
Black	2 (4%)
Asian	8 (17%)
Other	5 (11%)
Prefer not to answer	1 (2%)
Hispanic
Yes	7 (16%)
No	38 (84%)
Primary Language Spoken at Home
English	37 (80%)
Spanish	4 (9%)
Other	7 (15%)
Education Level
No high school	1 (2%)
High school diploma/GED	8 (17%)
Associate’s degree	4 (9%)
Bachelor’s degree or higher	33 (72%)
Health Insurance
Yes	36 (78%)
No	10 (22%)

Values are presented as count (percent). Percentages may not total 100 due to rounding or ability to select multiple responses

A large proportion had not been seen for a skin concern in the past year (n = 32, 70%) or had never attended a community screening event (n = 41, 89%). “Cost” (n = 13) and “I didn’t think it was necessary” (n = 13) were recorded as the largest barriers of seeing a healthcare provider for their skin. Only a small majority (n = 6, 13%) thought that accessing dermatologic services was “Very easy”. The majority of participants answered that they were “Very likely” or “Likely” (n = 39, 85%) to attend the event again, with more locations increasing the likelihood of attending (n = 22, 55%). About half of participants (n = 23, 50%) reported that they would not have had an annual skin check without the event. The majority (n = 44, 96%) of participants did not have any challenges getting to the event. The exact breakdown of participant responses can be found in Table 2.

Table 2.

Responses to event satisfaction survey items

Have any of the following prevented you from seeing a healthcare provider for your skin?	Count (Percent)
Appointment wait times	9 (20%)
Cost	13 (28%)
Lack of Insurance	8 (17%)
No nearby dermatology services	5 (11%)
Transportation issues	1 (2%)
I didn’t think it was necessary	13 (28%)
Other	1 (2%)
How easy do you think it is to access dermatology services?
Very easy	6 (13%)
Somewhat easy	18 (39%)
Difficult	9 (20%)
Very difficult	6 (13%)
Never tried	7 (15%)
In the past twelve months, how many times have you visited a healthcare provider for a skin concern?
0 times	32 (70%)
1 time	11 (24%)
2–3 times	3 (7%)
4 or more times	0
Is this your first experience at a community skin cancer screening event?
Yes	41 (89%)
No	5 (11%)
How likely are you to attend a similar community cancer event in the future?
Very unlikely	6 (13%)
Unlikely	0 (0%)
Neutral	1 (2%)
Likely	13 (28%)
Very likely	26 (57%)
What would make you more likely to attend a future event like this?
More locations	22 (55%)
More times available	10 (25%)
Shorter wait	0 (0%)
More educational materials	4 (10%)
Other	4 (10%)
Would you have had your skin checked this year if you were unable to attend a free event like this?
Yes	14 (30%)
No	23 (50%)
I’m not sure	9 (20%)
Did you have any challenges getting to the event today?
Yes	2 (4%)
No	44 (96%)

Values are presented as count (percent). Percentages may not total 100 due to rounding, ability to select multiple responses, or nonresponse from participants

Prior to the event, a total of 63 individuals registered for an appointment. However, during the event, a total of 48 individuals were screened. Although no lesions were identified as requiring biopsy, participants received a dermatologist-performed skin exam, counseling regarding sun protection and self skin-examination, and recommendation for follow-up based on their individual findings and history.

Race, categorized as White and Non-White because of small subgroup sample sizes, was associated with prior attendance of a free screening event (Fisher’s Exact test, p = 0.045). Race was associated with reporting “Cost” (Fisher’s Exact test, p = 0.0099) and “Lack of Insurance” (Fisher’s Exact test, p = 0.0016) as reasons for not having a skin exam. Age group was associated with prior attendance of a screening event (chi-square test, x² =11.01, df = 2, p = 0.004), with younger participants more likely to be first-time attendees than older participants.

Discussion/Conclusion

The findings from this study help identify the demographic characteristics of those who may need to be targeted for community-based skin screening events. More research is needed to identify factors promoting participation in community skin cancer screening events, as well as key barriers that inhibit access to dermatologic care in general. Despite being free and open to the public, the event primarily attracted participants who were White, English-speaking, college-educated, and insured. This profile may partially reflect the surrounding Kansas City Metro population, which is majority white and largely insured [7]. However, the event was held at an established free health clinic and hundreds of previous patients were contacted about attending the event, which may suggest additional barriers. The predominance of relatively advantaged participants suggests that free skin cancer screening events may not adequately reach underserved populations. This finding aligns with previous literature that showed preventive health initiatives tend to have an underrepresentation of minority and underserved populations [8]. Participants categorzed as Non-white were more likely to report no prior attendance at a free screening events and citing “Cost” or “Lack of Insurance” as barriers, may suggest a potential influence of social and economic determinants in shaping access to dermatologic care. However, given the relatively small convenience sample size of this study, race should be seen as a preliminary indicator rather than a predictor of attendance. Our results also suggested that younger age may be a predictor of never attending a screening, as previously supported by Cecconi et al. [9]. The relatively small sample size and multiple exploratory statistical comparisons within our study increase the possibility of type I error. Results should be interpreted cautiously and considered hypothesis-generating rather than definitive.

Barriers preventing individuals with skin of color from attending free community skin cancer screening events are multifactorial and include low awareness of melanoma risk, cultural beliefs about skin cancer susceptibility, systemic access barriers, lack of culturally appropriate outreach, and mistrust of the medical system; other commonly cited obstacles include cost, lack of insurance, transportation challenges, long travel distances to dermatology practices, limited appointment availability, and insufficient local specialty resources [10]. Similarly, our study found “Cost” and “Didn’t think it was necessary” as the largest barriers to seeing a healthcare provider about their skin; however, transportation was not demonstrated as a barrier in our study. Although most participants were insured, only 13% found accessing dermatologic care “very easy,” highlighting that barriers may extend beyond cost, such as limited appointment availability or long wait times that may make it difficult for patients to see a dermatologist in a flexible manner. 70% of respondents had not been evaluated for a skin concern in the past year, and 50% indicated they would not have pursued a skin examination if not for the event, agreeing with previous studies [5, 6]. High satisfaction rates and willingness to attend future events further support sustaining these community screening initiatives.

The current study demonstrates that community-based screenings may effectively reduce some of these access barriers by providing free, geographically accessible evaluations. However, the persistence of demographic disparities in attendance indicates that accessibility alone may be insufficient to ensure equity. Addressing this gap may require additional targeted outreach strategies that focus on traditionally underserved populations. Future screening initiatives should be strategically located within medically underserved neighborhoods and promoted through partnerships with community organizations that serve historically underserved populations. The American College of Surgeons recommends that cancer screening events partner with community organizations such as churches, schools, or health districts, and should include formal processes for follow-up on all positive findings [11]. Inclusion of culturally and linguistically appropriate educational materials and advertisements may help with reaching non-English-speaking and minority populations.

This study is limited in part by selection bias, in that patients who are more health-conscious or readily engaged in the healthcare system may be more aware of and/or likely to attend free events such as the one discussed. This also introduces an element of volunteer bias, as patients attending the event may report higher satisfaction rates than normal and may not be fully representative of the KC metropolitan area. Additionally, because this was a single-day single-site event, generalizability to larger populations may not be appropriate. An additional limitation is only creating advertising flyers in English, a decision that was guided by the standards for previous screening events at the institution. Additionally, our survey tool was only available in English due to limited resources. While this did not affect participation in our study, it could have if we had exclusively Spanish-speaking participants. Additional limitations are present in our statistical analysis. Categorizing race as “White” and “Non-white” may have obscured heterogeneity among racial and ethnic populations and should therefore be interpreted cautiously.

In the future, we plan to rectify some of our limitations by providing all advertising and study materials in English and Spanish. Future efforts should also incorporate long-term evaluation and management such as integrating recurring screening clinics into community health centers or primary care practices. This can promote continuity and normalize skin examinations as a component of routine preventive care. Additional interventions include connecting patients to cost-effective biopsy and treatment modalities should a suspicious lesion be found at these events. By emphasizing inclusivity and sustained engagement, future community skin cancer screening initiatives can better serve the populations most at risk, ultimately reducing preventable morbidity and mortality associated with skin cancer.

Author contributions

Each author has reviewed and takes full responsibility for the content of the manuscript.

Funding

Not applicable.

Data availability

The surveys that support the findings of this study are available in a REDCap Form with patient identifiers, and restrictions apply to the availability of this data, which is not publicly available. The data are, however, available upon request and with the permission of The University of Kansas IRB with patient identifiers removed.

Declarations

Human ethics approval and consent to participate

Study adhered to the Declaration of Helsinki.

Clinical trial number

Not applicable.

Consent to participate

Voluntary informed consent was obtained from all subjects.

Consent for publication

Obtained from all participants through signature of an IRB-approved consent form.

Competing interests

The authors declare no competing interests.