Impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making in melanoma care: A mixed methods study

Abstract

Background

The decision to perform a sentinel lymph node biopsy (SLNB) procedure can be guided by risk prediction tools. We aimed to investigate the impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making.

Methods

We conducted a mixed methods study using an online questionnaire and semi-structured interviews between April 2022 and March 2023. Australian clinicians and patients/carers who were using the Melanoma Institute Australia risk prediction tool were invited to participate.

Results

Sixty-one participants completed the questionnaire (52 clinicians including 36 general practitioners of whom 32 worked at skin cancer clinics; 14 surgeons; and 9 patients/carers). More than half of the clinicians reported that the tool had influenced the number of patients they were referring for SLNB procedures: 40 % reported increased referrals, 9 % reported fewer referrals, and 33 % reported no change. Over half (57 %) of the patient/carer participants reported using the risk tool alongside a clinician for shared decision-making. Interview findings suggested that the tool made clinicians feel more confident in their clinical decision to perform or refer patients for consideration of SLNB. Clinicians found the tool useful in guiding discussions about SLNB. However, there was uncertainty in interpreting risk scores if they had wide confidence intervals and some ambiguity in clinical decision-making if the risk score did not align with the clinician’s expectations.

Conclusion

This online risk prediction tool was acceptable to clinicians and patients/carers, useful for clinical decision-making and led to increased discussion between clinicians and patients regarding the SLNB procedure.