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Sarigöl Ordin Y, Demir Korkmaz F, Kankaya EA, Yeşilyaprak T. Factors Affecting Knowledge Levels and Protective Behaviors to Prevent the Development of Skin Cancer in Organ Transplant Recipients as a High-Risk Group. EXP CLIN TRANSPLANT 2023; 21:607-614. [PMID: 35037604 DOI: 10.6002/ect.2021.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Organ transplantrecipients are at high risk of skin cancer due to immunosuppressant therapy. This study investigated the factors affecting organ transplant recipients' knowledge and protective behaviors to prevent the development of skin cancer. MATERIALS AND METHODS This was a cross-sectional descriptive study of kidney (n = 82) and liver (n = 31) transplant recipients seen at our hospitals in Turkey from June 2019 to February 2020. A sociodemographic and clinical characteristics form, the Skin Cancer and Sun Knowledge scale, the Sun Protection Behavior questionnaire, and the General Self-Efficacy scale were used to collect data. RESULTS The mean age of organ transplant recipients was 46.63 ± 13.24 years. Self-efficacy and awareness that transplant increases the risk of skin cancer are 2 characteristics that affected the participants' knowledge level. The type of graft (kidney) affected participants' behavior in avoiding outdoor exposure between the hours of 10 am and 4 pm. Green/blue eye color and self-efficacy affected the participants' hatwearing behavior. These details showed that, as the patients' sensitivity and self-efficacy increased, their levels of knowledge and sun protection behaviors were positively affected. CONCLUSIONS The knowledge level of patients was affected by (1) awareness that transplant is associated with an increased risk of skin cancer and (2) high levels of self-efficacy. We observed that (1) organ transplant recipients with high self-efficacy and kidney transplant recipients were more likely to avoid outdoor exposure between 10 am and 4 pm and that (2) organ transplant recipients with green/blue eyes and high levels of selfefficacy were more likely to wear a hat when outdoors. Organ transplant teams should provide education and counseling about skin cancer and sun protection in the follow-up care of transplant recipients.
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Affiliation(s)
- Yaprak Sarigöl Ordin
- From the Department of Surgical Nursing, Dokuz Eylül University Nursing Faculty, Izmir, Turkey
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Thet Z, Lam AKY, Ng SK, Aung SY, Han T, Ranganathan D, Newsham S, Borg J, Pepito C, Khoo TK. An integrated skin cancer education program in renal transplant recipients and patients with glomerular disease. BMC Nephrol 2022; 23:361. [DOI: 10.1186/s12882-022-02997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractSun-protective strategies focusing on skin cancer awareness are needed in immunosuppressed patients at risk of skin cancers. The study aims to determine the effect of an integrated skin cancer education program on skin cancer awareness and sun-protective behaviours in renal transplant recipients (RTRs) and patients with glomerular disease (GD) treated with long-term immunosuppressants. A pilot prospective cohort study in Central Queensland, Australia was undertaken among adult RTRs and patients with GD, who completed survey questionaries on skin cancer and sun-health knowledge (SCSK), sun-protection practices and skin examination pre- and post-education. Fifty patients (25 RTRs, 25 patients with GD) participated in the study. All of them completed questionnaires at pre-, 3-month post-education and 92%(n = 46) at 6-month post-education. There was a significant increase in SCSK scores from baseline at 3-months (p < 0.001) and 6-months post-intervention (p < 0.01). Improved knowledge was retained for 6 months after education. There were changes in 2 of 8 photoprotective behaviours at 6 months. Interventional education enhanced regular self-skin examination rate (p < 0.001) as well as the frequency of full skin checks by general practitioners (GPs) (p < 0.001). Overall, RTRs had better compliance with sun-protective methods and higher skin examination rates by themselves and/ or GPs before and after the intervention of education compared to patients with GD. To conclude, an integrated skin cancer education program improved knowledge of skin cancer and skin health as well as the frequency of self-skin examination and formal skin assessments. However, improvement in patient compliance did not extend to other sun-protective practices.
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Upshaw SJ, Jensen JD, Giorgi EA, Pokharel M, Lillie HM, Adams DR, John KK, Wu YP, Grossman D. Developing skin cancer education materials for darker skin populations: crowdsourced design, message targeting, and acral lentiginous melanoma. J Behav Med 2022:10.1007/s10865-022-00362-x. [PMID: 36125669 DOI: 10.1007/s10865-022-00362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Despite decreased susceptibility, darker skin individuals who develop melanoma have worse survival. This disparity in melanoma mortality is the largest for any cancer, and partly driven by a lack of patient education materials targeted to darker skin populations in whom acral lentiginous melanoma (ALM) is the most common subtype. To address this communication disparity, the current study reports a multi-phase design process that leverages crowdsourcing and message testing to develop ALM-focused patient education materials for darker skin populations. Crowdsourced design was utilized to develop a pool of designs (phase 1), the pool was narrowed and thematically analyzed (phase 2), and select designs were evaluated via a message experiment (N = 1877). For darker skin populations, designs that depicted people enhanced knowledge of ALM through message memorability. The current study engages melanoma disparities by providing ALM patient education materials for darker skin populations vetted via a multi-phase process.
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Affiliation(s)
- Sean J Upshaw
- Moody College of Communication, University of Texas-Austin, Austin, TX, USA.
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth A Giorgi
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Manusheela Pokharel
- Department of Communication Studies, Texas State University, San Marcos, TX, USA
| | - Helen M Lillie
- Department of Communication Studies, University of Iowa, Iowa City, IA, USA
| | - Dallin R Adams
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kevin K John
- School of Communications, Brigham Young University, Provo, UT, USA
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
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Li D, Imbesi GJ, Yen L, Kim H, Sun CL, Crook CJ, Ballena R, Zhang YH, Allen R, Sedrak M, Singh G. Feasibility and Satisfaction of Using NET VITALS Self-assessment Tool Among Patients With Neuroendocrine Tumors. Pancreas 2022; 51:319-324. [PMID: 35775639 DOI: 10.1097/mpa.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES There is a lack of effective patient education regarding diagnosis/treatment of neuroendocrine tumors (NETs), possibly related to their rare incidence. METHODS In this cross-sectional survey study, NET patients attending the 2019 Annual Los Angeles NET Education Conference were approached to complete NET VITALS, a self-assessment tool gauging patients' perception/awareness of their NET diagnosis/treatment, and a satisfaction survey. Feasibility of NET VITALS, patient satisfaction with NET VITALS, and patients' perception/awareness of their NET diagnosis/treatment were evaluated. RESULTS This analysis included 68 patients (median age, 63 years; 47.1% gastrointestinal NETs; 88.2% metastatic disease). Participation was 88.3% (68/77), with a median of 85.7% of items completed (range, 61.9%-100.0%). More than 30% of the patients answered "Don't know/Not familiar"/left blank questions related to tumor characteristics, years of symptoms, and liver-directed therapies. In addition, 69.5% of the patients did not feel sufficient information about NETs was provided at diagnosis. Overall, 67.8% of the patients felt that NET VITALS provides topics to discuss with providers and 76.3% would recommend NET VITALS to others. CONCLUSIONS NET VITALS is a feasible and acceptable self-assessment tool to potentially help patients improve communication about their NET diagnosis/treatment with their physician. Further studies will examine NET VITALS' generalizability and discuss its incorporation into clinical care.
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Affiliation(s)
- Daneng Li
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
| | | | - Lisa Yen
- Los Angeles Carcinoid Neuroendocrine Tumor Society, Del Mar
| | - Heeyoung Kim
- Departments of Supportive Care Medicine, Center for Cancer and Aging
| | - Can-Lan Sun
- Departments of Supportive Care Medicine, Center for Cancer and Aging
| | - Christiana J Crook
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
| | - Richard Ballena
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
| | - Ya-Han Zhang
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
| | - Rebecca Allen
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
| | - Mina Sedrak
- From the Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte
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Khani Jeihooni A, Moradi M. The Effect of Educational Intervention Based on PRECEDE Model on Promoting Skin Cancer Preventive Behaviors in High School Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:796-802. [PMID: 29926433 DOI: 10.1007/s13187-018-1376-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
School-based education programs can be an effective way of educating adolescents about the dangers of exposure to sunlight and about preventive measures against this exposure and its relation to skin cancer. The aim of this study is to survey the effect of educational intervention based on the PRECEDE model on promoting skin cancer preventive behaviors in high school students of Fasa City, Fars Province, Iran. In this quasi-experimental study, 300 students (150 in experimental group and 150 in control group) in Fasa City, Fars Province, Iran, were selected in 2016-2017. The educational intervention for the experimental group consisted of six training sessions. A questionnaire consisting of demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure skin cancer preventive behaviors before and 4 months after the intervention. Data were analyzed using SPSS 22 and paired t test, independent t test, and chi-square test at a significance level of p < 0.05. The mean age of the students was 16.05 ± 1.76 years in the experimental group and 16.20 ± 1.71 years in the control group. Four months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, self-efficacy, enabling factors, social support, and skin cancer preventive behaviors compared to the control group. This study showed the effectiveness of the intervention based on the PRECEDE constructs in adoption of skin cancer preventive behaviors in 4 months post-intervention in students. Hence, this model can act as a framework for designing and implementing educational intervention for the prevention of skin cancer.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran.
| | - Milad Moradi
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran
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Cheng J, Widjajahakim R, Rajanala S, Maymone MBC, Secemsky E, Vashi NA. Effect of stimuli on sun protective habits: A randomized double-blind controlled study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:17-23. [PMID: 30058182 DOI: 10.1111/phpp.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Visual imagery has been shown to improve adherence to health messages but has scarcely been investigated in sun protection campaigns. OBJECTIVE To determine the effectiveness of pictorial- and textual-based sun protective messages in a largely Hispanic population. METHODS One hundred and forty-five participants received standard of care (SOC) as defined as sun protective counseling and were then randomized to receive either (a) images of sun damage, (b) a textual pamphlet about sun damage, or (c) no further messages. Analysis-of-variance tests for repeated measures were used to estimate the effects of the different stimuli on participants' knowledge and intention to sun protect. RESULTS All stimulus groups demonstrated an improvement in perceived effectiveness of sun protective habits (p < 0.05). However, pictorial and textual stimuli were both more effective than SOC in improving intentions to sun protect (p < 0.05), but there was no differential effect between the two. CONCLUSIONS Both pictorial and textual stimuli were more effective than SOC in improving intentions to sun protect, but there was no differential effect between the two.
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Affiliation(s)
- Judy Cheng
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Rafael Widjajahakim
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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Gellén E, Papp BG, Janka EA, Gáll T, Paragh G, Emri G, Nemes B, Remenyik É. Comparison of pre- and post-transplant sun-safe behavior of kidney transplant recipients: What is needed to improve? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:322-329. [DOI: 10.1111/phpp.12387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Emese Gellén
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Bence G. Papp
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Eszter A. Janka
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Tibor Gáll
- Department of Preventive Medicine; Faculty of Public Health; University of Debrecen; Debrecen Hungary
| | - György Paragh
- Department of Dermatology; Department of Cell Biology; Roswell Park Comprehensive Cancer Center; Buffalo NY USA
| | - Gabriella Emri
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Balázs Nemes
- Department of Surgery; Transplantation Centre; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - Éva Remenyik
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wu SZ, Jiang P, DeCaro JE, Bordeaux JS. A qualitative systematic review of the efficacy of sun protection education in organ transplant recipients. J Am Acad Dermatol 2016; 75:1238-1244.e5. [PMID: 27476105 DOI: 10.1016/j.jaad.2016.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 06/04/2016] [Accepted: 06/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transplant recipients are at increased risk of developing skin cancer as a result of chronic immunosuppression. Educating patients on sun protection has been routine posttransplantation, but to our knowledge, no systematic review has yet analyzed the efficacy of such education measures in this high-risk population. OBJECTIVE We sought to examine the efficacy of educating transplant recipients on skin cancer and sun protection. METHODS A literature search of interventional patient education studies published between January 1995 and March 2016 was performed in PubMed, CINAHL, Cochrane, and EMBASE databases. RESULTS Data from 7 studies meeting inclusion criteria were analyzed. No study attempted to examine the direct effect of sun protection education on skin cancer incidence in transplant recipients. Two randomized controlled trials showed that educational intervention can improve sun-protective behavior and decrease skin pigmentation or skin damage in sun-exposed areas. Three other randomized controlled trials compared the efficacy of 2 different forms of patient education at changing sun-protective behavior, but did not examine patient-oriented outcomes. LIMITATIONS A lack of high-quality randomized controlled trials with patient-oriented evidence and a dependence on self-reported data are limitations. CONCLUSION Sun protection education can be effective at altering patient behavior in transplant recipients, but its effect on posttransplantation skin cancer incidence remains to be elucidated.
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Affiliation(s)
- Sean Z Wu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pengsu Jiang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jessica E DeCaro
- Cleveland Health Sciences Library, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio.
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Robinson JK, Friedewald J, Gordon EJ. Perceptions of Risk of Developing Skin Cancer for Diverse Audiences: Enhancing Relevance of Sun Protection to Reduce the Risk. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:153-157. [PMID: 26209181 PMCID: PMC4881419 DOI: 10.1007/s13187-015-0885-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sixty-five percent of kidney transplant recipients (KTRs) develop squamous cell carcinoma (SCC). Perceptions of risk of developing skin cancer, amelioration of this risk with sun protection, and having choices among sun protection strategies may enhance sun protection use by KTRS, who are at greater risk than the general population. Thirty KTRs stratified among non-Hispanic Whites, non-Hispanic Blacks, and Hispanic/Latinos evaluated three versions of the interactive, web-based, electronic sun protection program and suggested refinements. The sequence of content presentation prepared the participant to accept the credibility, accuracy, and relevance of the message. Beginning with informing participants that using sun protection reduces the chance of developing skin cancer made the information credible to KTRs. Showing skin cancer on all skin types and patient testimonials enhanced participants' awareness of their susceptibility to develop skin cancer and primed patients to receive their personal risk of developing skin cancer. Coupling presentation of knowledge about the benefits of sun protection in reducing the risk of developing skin cancer with the personal risk of getting the disease was essential to KTRs believing that they could influence their health outcome.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 St. Clair Street, Suite 1260, Chicago, IL, 60611, USA.
| | - John Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J Gordon
- Center for Healthcare Studies and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Robinson JK, Guevara Y, Gaber R, Clayman ML, Kwasny MJ, Friedewald JJ, Gordon EJ. Efficacy of a sun protection workbook for kidney transplant recipients: a randomized controlled trial of a culturally sensitive educational intervention. Am J Transplant 2014; 14:2821-9. [PMID: 25395386 PMCID: PMC4236256 DOI: 10.1111/ajt.12932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/23/2014] [Accepted: 07/12/2014] [Indexed: 01/25/2023]
Abstract
A culturally sensitive educational intervention that encouraged sun protection behaviors among kidney transplant recipients (KTRs) was developed and the short-term efficacy was evaluated. Non-Hispanic White, Hispanic/Latino and non-Hispanic Black patients, who received a transplant 2-24 months prior to the study, were randomized into two study groups: intervention versus standard of care. Electronic reminders tailored to the weather conditions were sent every 2 weeks by text message or email. Self-reported surveys and biologic measurements were obtained prior to the intervention and 6 weeks later. Among the 101 study participants, there was a statistically significant increase in knowledge, recognition of personal risk of developing skin cancer, willingness to change sun protection behavior and self-reported performance of sun protection in participants receiving the intervention in comparison with those receiving standard of care (p < 0.05). The pigment darkening of the sun-exposed forearm and sun damage of the forearm and sunburns/skin irritation from the sun were significantly less in participants receiving the intervention (p < 0.05). Providing sun protection education at the beginning of summer with reminders tailored to weather conditions helped KTRs adopt sun protection practices. This sun protection program for KTRs may be incorporated into the care provided by the nephrologist or transplant surgeon.
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Affiliation(s)
- June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yanina Guevara
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rikki Gaber
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marla L. Clayman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary J. Kwasny
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John J. Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elisa J. Gordon
- Center for Healthcare Studies & Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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