Practical Interventions to Optimize Patient Adherence in Dermatologic Surgery and Mohs Micrographic Surgery: A Review.

[BACKGROUND] Patient nonadherence is a leading cause of treatment failure, suboptimal outcomes, and increased health care utilization. Adherence is also suboptimal in dermatologic surgery and Mohs micrographic surgery (MMS), despite playing a vital role in the surgical outcome. Poor adherence may lead to untreated skin cancers, complications such as flap or graft necrosis, and low patient satisfaction due to inferior cosmesis.

[OBJECTIVE] To outline targeted, practical interventions, the dermatologic surgeon can implement to improve outcomes in patients at risk for poor adherence.

[MATERIALS AND METHODS] Searches of MEDLINE and Scopus were conducted using a search strategy to identify articles discussing adherence and dermatologic surgery. Articles were assessed for level of evidence, and recommendations were assigned a grade according to the system outlined by the Oxford Centre for Evidence-Based Medicine.

[RESULTS] Thirty-six interventions-using evidence-based behavioral principles such as anchoring, salience, and "white coat compliance"-to improve patient adherence in the preoperative, intraoperative, and postoperative settings are described.

[CONCLUSION] Poor patient adherence is common in dermatologic surgery, and MMS and can lead to surgical complications and suboptimal outcomes. Understanding the scope and reasons for poor adherence may allow the dermatologic surgeon to assess adherence, determine the rationale for nonadherence, and implement practical interventions to optimize adherence.