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Ackermann DM, Bracken K, Janda M, Turner RM, Hersch JK, Drabarek D, Bell KJL. Strategies to Improve Adherence to Skin Self-examination and Other Self-management Practices in People at High Risk of Melanoma: A Scoping Review of Randomized Clinical Trials. JAMA Dermatol 2023; 159:432-440. [PMID: 36857048 DOI: 10.1001/jamadermatol.2022.6478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Importance Adherence, both in research trials and in clinical practice, is crucial to the success of interventions. There is limited guidance on strategies to increase adherence and the measurement and reporting of adherence in trials of melanoma self-management practices. Objective This scoping review aimed to describe (1) strategies to improve adherence to self-management practices in randomized clinical trials of people at high risk of melanoma and (2) measurement and reporting of adherence data in these trials. Evidence Review Four databases, including MEDLINE, Embase, CENTRAL, and CINAHL, were searched from inception to July 2022. Eligible studies were randomized clinical trials of self-monitoring interventions for early detection of melanoma in people at increased risk due to personal history (eg, melanoma, transplant, dysplastic naevus syndrome), family history of melanoma, or as determined by a risk assessment tool or clinical judgment. Findings From 939 records screened, 18 eligible randomized clinical trials were identified, ranging in size from 40 to 724 participants, using a range of adherence strategies but with sparse evidence on effectiveness of the strategies. Strategies were classified as trial design (n = 15); social and economic support (n = 5); intervention design (n = 18); intervention and condition support (n = 10); and participant support (n = 18). No strategies were reported for supporting underserved groups (eg, people who are socioeconomically disadvantaged, have low health literacy, non-English speakers, or older adults) to adhere to self-monitoring practices, and few trials targeted provider (referring to both clinicians and researchers) adherence (n = 5). Behavioral support tools included reminders (n = 8), priority-setting guidance (n = 5), and clinician feedback (n = 5). Measurement of adherence was usually by participant report of skin self-examination practice with some recent trials of digital interventions also directly measuring adherence to the intervention through website or application analytic data. Reporting of adherence data was limited, and fewer than half of all reports mentioned adherence in their discussion. Conclusions and Relevance Using an adaptation of the World Health Organization framework for clinical adherence, this scoping review of randomized clinical trials identified key concepts as well as gaps in the way adherence is approached in design, conduct, and reporting of trials for skin self-examination and other self-management practices in people at high risk of melanoma. These findings may usefully guide future trials and clinical practice; evaluation of adherence strategies may be possible using a Study Within A Trial (SWAT) framework within host trials.
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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Bracken
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Niu Z, Heckman CJ. Digital Educational Strategies to Teach Skin Self-examination to Individuals at Risk for Skin Cancer. JOURNAL OF HEALTH COMMUNICATION 2022; 27:790-800. [PMID: 36625227 DOI: 10.1080/10810730.2022.2157910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Skin cancer is the most common cancer in the United States, and early detection of melanoma may lead to diagnosis of thinner and more treatable cancers, resulting in improved survival rates. This study examined the effects of message interactivity (high vs. low) and imagery (cartoon, real human character, or customized imagery preference) on accuracy of identifying abnormal skin lesions (ASL) and skin self-examination (SSE) intention. This study employed a 3 (cartoon character vs. real person vs. customization) x 2 (high interactivity vs. low interactivity) between-subjects online experimental design. Participants at risk for skin cancer were randomly assigned to one of the six conditions and completed a survey after reviewing the educational materials. Univariate analyses were conducted to detect group differences on the accuracy of identifying ASL and intention to conduct SSE in the next 3 months. Among 321 participants who completed the study, the mean age was 36.61 years, 56.7% were females, 76.1% had a college or higher degree, and over 60% self-identified as non-Hispanic White. Individuals in the high interactivity and customization group (compared to the low interactivity and cartoon group) were more likely to accurately identify ASL. Individuals in the high interactivity and customization or low interactivity and real person imagery groups (compared to the low interactivity and cartoon group) reported higher intention to conduct SSE in the next 3 months. These results suggest that customization and interactivity may be beneficial for educational programs or intervention design to improve both melanoma identification and SSE intention.
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Affiliation(s)
- Zhaomeng Niu
- Department of Health Informatics, Rutgers School of Health Professions, Piscataway, New Jersey, United States
| | - Carolyn J Heckman
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
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Pagliarello C, Girardelli CR. Using Patient's Smartphone as an Aid to Improve Skin Self-Examination. Dermatol Surg 2021; 47:1676. [PMID: 34608098 DOI: 10.1097/dss.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manne SL, Marchetti MA, Kashy DA, Heckman CJ, Ritterband LM, Thorndike FP, Viola A, Lozada C, Coups EJ. mySmartCheck, a Digital Intervention to Promote Skin Self-examination Among Individuals Diagnosed With or at Risk for Melanoma: A Randomized Clinical Trial. Ann Behav Med 2021; 56:791-803. [PMID: 34637495 DOI: 10.1093/abm/kaab090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Regular skin self-examination (SSE) reduces melanoma mortality but is not often conducted. PURPOSE To promote SSE performance in individuals at increased risk for melanoma. METHODS One hundred sixteen individuals at heightened risk for development of melanoma (i.e., personal/family history of melanoma, high-risk mole phenotype) who did not conduct a thorough SSE during in the prior 3 months were randomly assigned to receive either an automated internet-based intervention (mySmartCheck) or usual care (UC). One hundred sixteen participants completed surveys before random assignment and 99 completed the follow-up survey 13-weeks afterward. The primary outcome was participant self-reported examination (SSE) of all 15 parts of the body in the last 3 months. Secondary outcomes were SSE of any part of the body in the last 3 months and number of body parts examined during the last SSE. RESULTS More mySmartCheck participants examined all 15 body parts (32.6% vs. 7.1%, p = .001). More individuals in mySmartCheck reported conducting SSE on any body part than those in UC (81.4% vs. 62.5%, p = .04). Effect sizes were large (d = 1.19 all 15 body parts) to moderate (d = 0.55 for any body part). mySmartCheck participants examined more body areas than UC participants (12.7 vs. 10.3, p = 0.003) during the last SSE. Participants in mySmartCheck reported higher levels of knowledge of suspicious lesions, SSE benefits, SSE self-efficacy, and planning for SSE, and lower SSE barriers, than those assigned to UC. CONCLUSIONS mySmartCheck had a significant positive impact on SSE performance and behaviors. Additional research with a larger sample size, a longer follow-up, and more varied clinical settings is needed. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT03725449 (https://clinicaltrials.gov/ct2/show/NCT03725449).
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
| | - Lee M Ritterband
- Center for Behavioral Health & Technology, University of Virginia, Charlottesville, VA, USA
| | | | - Adrienne Viola
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
| | - Carolina Lozada
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
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Narayanamurthy V, Padmapriya P, Noorasafrin A, Pooja B, Hema K, Firus Khan AY, Nithyakalyani K, Samsuri F. Skin cancer detection using non-invasive techniques. RSC Adv 2018; 8:28095-28130. [PMID: 35542700 PMCID: PMC9084287 DOI: 10.1039/c8ra04164d] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/22/2018] [Indexed: 12/22/2022] Open
Abstract
Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.
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Affiliation(s)
- Vigneswaran Narayanamurthy
- InnoFuTech No: 42/12, 7th Street, Vallalar Nagar, Pattabiram Chennai Tamil Nadu 600072 India
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
| | - P Padmapriya
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - A Noorasafrin
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - B Pooja
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - K Hema
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - Al'aina Yuhainis Firus Khan
- Department of Biomedical Science, Faculty of Allied Health Sciences, International Islamic University Malaysia 25200 Kuantan Pahang Malaysia
| | - K Nithyakalyani
- Department of Biomedical Engineering, Veltech Multitech Dr. RR & Dr. SR Engineering College Chennai 600 062 India
| | - Fahmi Samsuri
- Faculty of Electrical and Electronics Engineering, University Malaysia Pahang Pekan 26600 Malaysia
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Erkin Ö, Ardahan M, Temel AB. Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:52-58. [PMID: 27113468 DOI: 10.1007/s13187-016-1037-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.
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Affiliation(s)
- Özüm Erkin
- Faculty of Nursing, Department of Public Health Nursing, Ege University, Bornova, Izmir, Turkey.
| | - Melek Ardahan
- Faculty of Nursing, Department of Public Health Nursing, Ege University, Bornova, Izmir, Turkey
| | - Ayla Bayık Temel
- Faculty of Nursing, Department of Public Health Nursing, Ege University, Bornova, Izmir, Turkey
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Czajkowska Z, Hall NC, Sewitch M, Wang B, Körner A. The role of patient education and physician support in self-efficacy for skin self-examination among patients with melanoma. PATIENT EDUCATION AND COUNSELING 2017; 100:1505-1510. [PMID: 28268053 DOI: 10.1016/j.pec.2017.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/24/2017] [Accepted: 02/21/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This project aims to elucidate the relationships between skin self-examination (SSE), perceived physician support of SSE, and self-efficacy for SSE among melanoma patients. METHODS A longitudinal study of patients diagnosed with melanoma was conducted over the span of 18 months. Participants filled out questionnaires at four assessment points and participated in an SSE education about the early signs of melanoma. RESULTS Among the 242 patients enrolled, the level of self-efficacy for SSE was 23% higher immediately after the educational intervention (p<.001) and the increase was retained three months (p<.001) and twelve months later (p<.001). Additionally, a one-way repeated measures ANOVA revealed that the perceived physician support of SSE positively corresponded to the level of patient self-efficacy with higher patient-reported physician support being related to higher self-efficacy (p=.001). CONCLUSION Patient education and perceived physician support of SSE are positively associated with patients' level of self-efficacy. PRACTICE IMPLICATIONS Physicians caring for melanoma survivors should be aware that, both SSE education and patients' perception of high physician support of SSE may be associated with higher self-efficacy for checking one's own skin for signs of cancer recurrence.
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Affiliation(s)
- Z Czajkowska
- McGill University, Dept. of Educational and Counselling Psychology, 3700 rue McTavish, Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - N C Hall
- McGill University, Dept. of Educational and Counselling Psychology, 3700 rue McTavish, Room 543, Montreal, Quebec H3A 1Y2, Canada.
| | - M Sewitch
- McGill University Health Centre, Div. of Clinical Epidemiology, V-building Room V2.15, 687, Avenue des Pins Ouest, Montreal, Quebec H3A 1A1, Canada.
| | - B Wang
- McGill University Health Centre, Melanoma Clinic, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - A Körner
- McGill University, Dept. of Educational and Counselling Psychology, 3700 rue McTavish, Room 614, Montreal, Quebec H3A 1Y2, Canada.
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Marino ML, Carrera C, Marchetti MA, Marghoob AA. Practice Gaps in Dermatology: Melanocytic Lesions and Melanoma. Dermatol Clin 2016; 34:353-62. [PMID: 27363893 DOI: 10.1016/j.det.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early detection remains the most important strategy to reduce melanoma mortality. The identification and evaluation of new or changing skin lesions are important components of melanoma screening and are best performed today using complementary noninvasive imaging technologies, such as total body photography (TBP), dermoscopy, sequential digital dermoscopic imaging (SDDI), and reflectance confocal microscopy (RCM). Despite strong evidence showing that these screening techniques improve diagnostic accuracy for melanoma, they are not widely used by dermatologists. In this practice gaps review, the authors highlight the use, evidence, and rationale for TBP, dermoscopy, SDDI, and RCM.
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Affiliation(s)
- Maria L Marino
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Cristina Carrera
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA; Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, CIBERER, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
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McWhirter JE, Hoffman-Goetz L. A systematic review of visual image theory, assessment, and use in skin cancer and tanning research. JOURNAL OF HEALTH COMMUNICATION 2014; 19:738-757. [PMID: 24512597 DOI: 10.1080/10810730.2013.837562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Visual images increase attention, comprehension, and recall of health information and influence health behaviors. Health communication campaigns on skin cancer and tanning often use visual images, but little is known about how such images are selected or evaluated. A systematic review of peer-reviewed, published literature on skin cancer and tanning was conducted to determine (a) what visual communication theories were used, (b) how visual images were evaluated, and (c) how visual images were used in the research studies. Seven databases were searched (PubMed/MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, Social Sciences Full Text, ERIC, and ABI/INFORM) resulting in 5,330 citations. Of those, 47 met the inclusion criteria. Only one study specifically identified a visual communication theory guiding the research. No standard instruments for assessing visual images were reported. Most studies lacked, to varying degrees, comprehensive image description, image pretesting, full reporting of image source details, adequate explanation of image selection or development, and example images. The results highlight the need for greater theoretical and methodological attention to visual images in health communication research in the future. To this end, the authors propose a working definition of visual health communication.
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Affiliation(s)
- Jennifer E McWhirter
- a School of Public Health and Health Systems, University of Waterloo , Waterloo , Ontario , Canada
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Yagerman S, Marghoob A. Melanoma patient self-detection: a review of efficacy of the skin self-examination and patient-directed educational efforts. Expert Rev Anticancer Ther 2014; 13:1423-31. [DOI: 10.1586/14737140.2013.856272] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Visual images for patient skin self-examination and melanoma detection: A systematic review of published studies. J Am Acad Dermatol 2013; 69:47-55. [DOI: 10.1016/j.jaad.2013.01.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/18/2013] [Accepted: 01/23/2013] [Indexed: 11/21/2022]
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McLoone J, Menzies S, Meiser B, Mann GJ, Kasparian NA. Psycho-educational interventions for melanoma survivors: a systematic review. Psychooncology 2012; 22:1444-56. [DOI: 10.1002/pon.3165] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Jordana McLoone
- School of Women's and Children's Health, Faculty of Medicine; University of New South Wales; Sydney NSW Australia
| | - Scott Menzies
- Sydney Melanoma Diagnostic Centre; Royal Prince Alfred Hospital; Camperdown NSW Australia
- Discipline of Dermatology, Sydney Medical School; University of Sydney; Camperdown NSW Australia
| | - Bettina Meiser
- Psychosocial Research Group, Department of Medical Oncology; Prince of Wales Hospital; Sydney NSW Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney NSW Australia
| | - Graham J. Mann
- Westmead Institute for Cancer Research; University of Sydney at Westmead Millennium Institute; NSW Australia
| | - Nadine A. Kasparian
- School of Women's and Children's Health, Faculty of Medicine; University of New South Wales; Sydney NSW Australia
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Self-examination behaviors for syphilis symptoms among HIV-infected men. J Acquir Immune Defic Syndr 2010; 55:284-5. [PMID: 20859086 DOI: 10.1097/qai.0b013e3181e13ed9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hollands GJ, Hankins M, Marteau TM. Visual feedback of individuals' medical imaging results for changing health behaviour. Cochrane Database Syst Rev 2010:CD007434. [PMID: 20091633 DOI: 10.1002/14651858.cd007434.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Feedback of medical imaging results can reveal visual evidence of actual bodily harm attributable to a given behaviour. This may offer a particularly promising approach to motivating changes in health behaviour to decrease risk. Applicable behaviours include smoking cessation, skin self-examination, sun protection behaviour, dietary intake, physical activity and medication usage. The current review assembles and evaluates the evidence concerning the behavioural impact of showing and explaining images, in order to determine whether their communication is an effective intervention approach. OBJECTIVES To assess the extent to which feedback to individuals of images of their own bodies created during medical imaging procedures increases or decreases a range of health behaviours. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14 September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9 October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of articles. We also contacted authors of selected papers, and searched the ProQuest Dissertations and Theses database on 1 October 2009 for grey literature. SELECTION CRITERIA Randomised or quasi-randomised controlled trials involving adult (18 years and over) non-pregnant individuals undergoing medical imaging procedures assessing risk of disease or of an existing condition, for which personal risk may be reduced by modification of behaviour. The sole or principal component of included interventions is visual feedback of individuals' medical imaging results, defined as individuals being shown, and having explained, source images (still or moving images) of their bodies generated by the procedure. DATA COLLECTION AND ANALYSIS Two authors searched for studies and independently extracted data from included studies, with disagreements resolved by consensus and a third author acting as arbiter. The risk of bias of included studies was assessed and reported in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a narrative synthesis of the included studies, dividing them into clinical and non-clinical population groups and presenting major characteristics and results. Where the studies were sufficiently similar in terms of population, inclusion criteria, interventions and/or outcomes, we pooled the data statistically. MAIN RESULTS We included nine trials involving 1371 participants. Overall, results were mixed. Regarding five trials in clinical populations, three assessed smoking cessation behaviours, all featuring arterial scanning procedures to assess cardiovascular risk, and reported a statistically significant effect favouring the intervention, producing a pooled odds ratio (OR) of 2.81 (95% confidence interval (CI) 1.23 to 6.41, P = 0.01). One of these trials also measured physical activity and reported no statistically significant difference between the groups. A further trial measured skin examination behaviour following a skin photography procedure for assessing moles, and reported a statistically significant increase in favour of the intervention, with an OR of 4.86 (95% CI 1.95 to 12.10, P = 0.0007). The final clinical population trial measured a range of dietary intake and medication usage behaviours and featured an arterial scanning procedure assessing cardiovascular risk, and reported no statistically significant effects.Among the four trials in non-clinical populations, all featuring ultraviolet (UV) photography to highlight UV-related skin damage, a statistically significant result favouring the intervention was found in one trial for reducing tanning booth use, producing a mean difference (MD) of -1.10 (95% CI -1.90 to -0.30, P = .007) and one trial reported an outcome on which the control condition was favoured, with an MD of 0.45 (95% CI 0.04 to 0.86, P = 0.03) on intentional hours spent in the sun. In two further trials, no statistically significant behavioral effects were reported regarding time spent in the sun or sun protection behaviours.There was no evidence of significant adverse effects in the included trials, although this was not well reported. AUTHORS' CONCLUSIONS Due to the limited nature of the available evidence and the mixed results that were found, no strong statements can be made about the effectiveness of communicating medical imaging results to change health behaviour. Only three trials in clinical populations were similar enough in term of setting, intervention and outcome to allow meta-analysis. We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviours, but that this should be considered on an intervention by intervention basis, and not assumed as a general principle.
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Affiliation(s)
- Gareth J Hollands
- Health Psychology Section, King's College London, 5th Floor, Bermondsey Wing, Guy's Campus, London, UK, SE1 9RT
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Boone SL, Stapleton J, Turrisi R, Ortiz S, Robinson JK, Mallett KA. Thoroughness of skin examination by melanoma patients: influence of age, sex and partner. Australas J Dermatol 2009; 50:176-80. [PMID: 19659978 DOI: 10.1111/j.1440-0960.2009.00533.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the thoroughness of deliberate skin examination by people with a history of melanoma. Patients were randomized into one of two conditions: either to receive the brief educational and skills training intervention alone or as a couple with their spouse or cohabiting partner. Subjects recorded concerning lesions on body maps. At the 4-month visit, a total body skin examination was performed by a dermatologist blinded to the subjects' condition and to their recorded responses. The skin surface was divided according to the region's visibility during skin self-examination and sexual connotations: visible/not sexually sensitive, non-visible/not sexually sensitive and sexually sensitive. The primary point of comparison was missed lesions, defined as the difference between lesions recorded by the subjects and their partners and those recorded by the dermatologist. Among 130 participants, 56 subjects reported partner assistance while performing SSE. Participants missed more lesions in sexually sensitive areas than in the other regions. With the increasing age of the patient, the number of missed lesions in non-visible/not sexually sensitive and sexually sensitive areas decreased. Male patients assisted by female partners missed fewer lesions in all three regions than female patients assisted by male partners. In easily visible areas, male patients missed significantly fewer lesions than female patients (P = 0.01). Older couples performed more thorough partner-assisted skin examinations in non-visible and sexually sensitive areas than younger couples. Male patients who were assisted by female partners performed more thorough partner-assisted skin examinations than female patients assisted by male partners.
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Affiliation(s)
- Susan L Boone
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Abstract
The incidence of cutaneous melanoma has increased substantially in most white populations during the past several decades. Despite improvements in the early recognition of melanoma and the use of novel diagnostic techniques that enhance our diagnostic capabilities, disease-related mortality remains a significant public health issue. In the absence of effective treatment approaches for advanced disease, the best means for reducing deaths by melanoma are screening as well as professional and public education. The role of population-or community-based screening remains controversial, but evidence from self-selected screening campaigns, health care professional surveillance, and specialized pigmented lesions clinics underscores the value of screening and early detection programs, particularly in high-risk groups. Annual screening campaigns coupled with intense media promotion have become commonplace in many countries, and despite their low yield of melanoma detection, the dissemination of educational material and information to the public during these events is important in increasing public awareness. Future directions should include using screening campaigns to target middle-aged and older men and persons of lower socioeconomic status, who suffer most from the burden of the disease and its associated mortality. On a worldwide scale, comprehensive educational and screening campaigns should be implemented or intensified in underserved areas and geographic regions with lower survival rates, such as Eastern European countries. A better understanding of the biology of the disease, already occurring with notable strides, will help us to define better those individuals who will benefit most from screening and early detection efforts. Technologic advances and new diagnostic modalities will afford a more reliable and vigilant surveillance of high-risk individuals, whereas the wide use of the Internet will enhance the distribution of relevant information to the public with the ultimate goal of achieving a better control of melanoma.
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Affiliation(s)
- Alexander J Stratigos
- Department of Dermatology, University of Athens Medical School, Andreas Sygros Hospital, Athens 16121, Greece
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Hamidi R, Cockburn MG, Peng DH. Prevalence and predictors of skin self-examination: prospects for melanoma prevention and early detection. Int J Dermatol 2009; 47:993-1003. [PMID: 18986343 DOI: 10.1111/j.1365-4632.2008.03780.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Reyhaneh Hamidi
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, California 90089, USA.
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Robinson JK, Stapleton J, Turrisi R. Relationship and partner moderator variables increase self-efficacy of performing skin self-examination. J Am Acad Dermatol 2008; 58:755-62. [PMID: 18258332 DOI: 10.1016/j.jaad.2007.12.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 12/08/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We sought to identify relationship and partner-related moderating variables that influence the effectiveness of both a couples and a solo learning intervention designed to increase skin self-examination behavior in a sample of patients at risk for developing melanoma. METHODS Patients received a brief intervention designed to teach skin self-examination skills and were randomly assigned into either a solo learning condition where the intervention was administered to the patient alone (n = 65) or a couple learning condition where the intervention was administered to the patient and patient's spouse or cohabiting partner (n = 65). The main outcome measure was skin self-examination self-efficacy, which is the strongest mediator of skin self-examination. The relationship moderator variables measured were quality of relationship, partner motivation, and ability to assist in implementation of the intervention. RESULTS When quality of the marital/partner relationship was high, the beneficial effects provided by the partner being included in the skin self-examination skills training were the highest and patients exhibited higher self-efficacy. Similar effects were observed for those with partners who were motivated to implement the intervention, and for those with partners high in ability to provide support. LIMITATIONS Study limitations include the need to evaluate whether the effects can be sustained long term and the exclusion of patients with melanoma without partners. CONCLUSIONS The amount of beneficial effects gained by the patient from the skin self-examination intervention was influenced by marital/partner relationships. Clinicians may need to consider these relationship and partner characteristics when communicating to patients about skin cancer screening.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Geller AC, Swetter SM, Brooks K, Demierre MF, Yaroch AL. Screening, early detection, and trends for melanoma: Current status (2000-2006) and future directions. J Am Acad Dermatol 2007; 57:555-72; quiz 573-6. [PMID: 17870429 DOI: 10.1016/j.jaad.2007.06.032] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 06/13/2007] [Accepted: 06/27/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED In the past 5 years, there have been notable strides toward the earlier recognition and discovery of melanoma, including new technologies to complement and augment the clinical examination and new insights to help clinicians recognize early melanoma. However, incidence and mortality rates throughout most of the developed world have risen over the past 25 years, while education and screening, potentially the best means for reducing the disease, continue to be severely underutilized. Much progress needs to be made to reach middle-aged and older men and persons of lower socioeconomic status who suffer a disproportionate burden of death from melanoma. Worldwide melanoma control must also be a priority, and comprehensive educational and screening programs should be directed to Northern Ireland and a number of Eastern European nations, whose 5-year survival rates range between 53% and 60%, mirroring those of the United States and Australia more than 40 years ago. LEARNING OBJECTIVE After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.
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Affiliation(s)
- Alan C Geller
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Hay JL, Oliveria SA, Dusza SW, Phelan DL, Ostroff JS, Halpern AC. Psychosocial Mediators of a Nurse Intervention to Increase Skin Self-examination in Patients at High Risk for Melanoma. Cancer Epidemiol Biomarkers Prev 2006; 15:1212-6. [PMID: 16775183 DOI: 10.1158/1055-9965.epi-04-0822] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months.
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Affiliation(s)
- Jennifer L Hay
- Behavioral Sciences Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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21
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Loescher LJ, Harris RB, Lim KH, Su Y. Thorough skin self-examination in patients with melanoma. Oncol Nurs Forum 2006; 33:633-7. [PMID: 16676019 DOI: 10.1188/06.onf.633-637] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the feasibility of using Weinstock et al.'s thorough skin self-examination (TSSE) assessment in patients with melanoma, to describe TSSE characteristics of patients with melanoma, and to explore associations of personal and disease variables with TSSE. DESIGN Cross-sectional, descriptive feasibility study; part of a larger study of melanoma in families. SETTING Outpatient melanoma clinics in a National Cancer Institute-designated comprehensive cancer center. SAMPLE Purposive sample of 70 predominantly white participants (47% women, 53% men), with a mean age of 65 years (SD = 11 years) and pathologically confirmed cutaneous melanoma (any stage). METHODS Weinstock et al.'s TSSE assessment (self-report of the number of times patients examined the surface of seven specific body areas during the prior two months) and items regarding partnered TSSE and skin examination from healthcare providers. MAIN RESEARCH VARIABLES Frequency of TSSE and healthcare provider skin examination, partnered TSSE, and reasons for not performing TSSE. FINDINGS Forty-one (59%) participants reported performing TSSE; by Weinstock et al.'s criteria, only 23 (33%) practiced TSSE. Use of a partner was significantly associated with TSSE (p = 0.001); patients indicated high rates of skin examination by healthcare providers. CONCLUSIONS Patients with melanoma are at high risk for recurrent disease. TSSE contributes to early detection of melanoma. Although Weinstock et al.'s TSSE assessment is feasible for use among patients with melanoma in a clinical setting, the focus should be on examination of specific body areas, rather than global skin examination. Overall, patients with melanoma had a low frequency of TSSE; however, data regarding previous knowledge or instruction of TSSE were not collected. Involving a partner enhances the frequency of TSSE. IMPLICATIONS FOR NURSING Patients with melanoma should be informed of the importance of conducting systematic TSSE and using a partner during examination; however, some patients may prefer skin examination by healthcare providers. Measurement of TSSE self-report merits further study.
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Affiliation(s)
- Lois J Loescher
- College of Nursing and the Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
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Nyawata ID, Topping AE. Symptom interpretation as a source of delay in malignant melanoma presentation — A literature review. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cein.2006.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oliveria SA, Dusza SW, Phelan DL, Ostroff JS, Berwick M, Halpern AC. Patient adherence to skin self-examination. effect of nurse intervention with photographs. Am J Prev Med 2004; 26:152-5. [PMID: 14751328 DOI: 10.1016/j.amepre.2003.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.
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Affiliation(s)
- Susan A Oliveria
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
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