Patient perceptions of Mohs micrographic surgery during the COVID‐19 pandemic and lessons for the next outbreak

Understanding patient experiences of healthcare systems during the pandemic is important to help strategize for future similar events. We operated a reduced Mohs micrographic surgery (MMS) service during the pandemic by rationalizing patients by tumour type, age, comorbidities and patient choice. We sought to establish patient expectations and concerns of attending for MMS by conducting a survey of those attending surgery over a 7‐week period from 24 April 2020. The results are particularly relevant when re‐establishing services in preparation for an expected upsurge of routine activity (including surgical procedures) or ‘second spike’ of COVID‐19 cases later this year.

Although patients who may not have attended surgery were not surveyed, 37% of patients had at least one risk factor for COVID‐19 and 27% were over the age of 70 years. Furthermore, we also had a high response rate of 96% (151 responses) reflecting an accurate representation of patient experiences.

Of the survey respondents, 52% were male and 48% female and the majority (98%) white. The age range was 30–89 years and the majority (91%) described their health status as good to excellent.

Our main findings were that the overwhelming majority of patients (82%) were relieved to have surgery. Nearly half (47%) had been worried the hospital would cancel their surgery. Only 17% considered cancelling due to concerns about contracting coronavirus, transmitting to household/family members, or taking public transport, although 54% were anxious about using public transport to attend their appointment. The overwhelming majority (80%) stated they would normally have used public transport if there was not an ongoing pandemic, but only 45% actually did.

Less than a quarter were concerned they would contract COVID‐19 in hospital and 30% were concerned about transmitting to household/family members. Only 19% were concerned about the ability to social distance in hospital. Despite these concerns, patients still attended for MMS.

To our knowledge, this is the first study exploring patient perceptions of MMS during the pandemic. Patients overwhelmingly appreciated having MMS treatment in a safe environment. There were some COVID‐19‐related concerns; however, patients felt that attending their appointment was more important. Relatively few patients were concerned about being able to socially distance in hospital; this may reflect our strong infection‐control measures¹ and effective communication, including a nurse‐led consultation prior to the appointment. During this consultation, patients were given information about infection‐control measures and had the opportunity to ask questions. The main limitation is we surveyed patients who actually attended hospital for surgery, although a third of patients had COVID‐19 risk factors and over a quarter were over 70 years old.

In conclusion, it is clear that patients strongly appreciated continued MMS services during the pandemic and continuation of surgery helps reduce treatment delays and backlogs. Our key lessons for any future pandemic or second wave are that MMS services should continue to run with patients prioritized based on clinical judgement and limiting risks. Effective patient communication is vital prior to surgery to prepare patients and alleviate their concerns. Finally, it is important that multiple infection‐control measures are implemented to reduce transmission. We can and should strive to continue to deliver high‐quality care and reduce associated risks to provide the best outcomes for patients. This will be critical in any second wave or future pandemics.