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Ribeiro N, Tavares P, Ferreira C, Coelho A. Melanoma prevention using an augmented reality-based serious game. Patient Educ Couns 2024; 123:108226. [PMID: 38442436 DOI: 10.1016/j.pec.2024.108226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The purpose of this study was to field-test a recently developed AR-based serious game designed to promote SSE self-efficacy, called Spot. METHODS Thirty participants played the game and answered 3 questionnaires: a baseline questionnaire, a second questionnaire immediately after playing the game, and a third questionnaire 1 week later (follow-up). RESULTS The majority of participants considered that the objective quality of the game was high, and considered that the game could have a real impact in SSE promotion. Participants showed statistically significant increases in SSE self-efficacy and intention at follow-up. Of the 24 participants that had never performed a SSE or had done one more than 3 months ago, 12 (50.0%) reported doing a SSE at follow-up. CONCLUSIONS This study provides supporting evidence to the use of serious games in combination with AR to educate and motivate users to perform SSE. Spot seems to be an inconspicuous but effective strategy to promote SSE, a cancer prevention behavior, among healthy individuals. PRACTICE IMPLICATIONS Patient education is essential to tackle skin cancer, particularly melanoma. Serious games, such as Spot, have the ability to effectively educate and motivate patients to perform a cancer prevention behavior.
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Affiliation(s)
- Nuno Ribeiro
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Ipatimup - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Portugal.
| | - Pedro Tavares
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Ipatimup - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Portugal, Faculdade de Engenharia da Universidade do Porto, Portugal
| | - Catarina Ferreira
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Ipatimup - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Portugal, Faculdade de Engenharia da Universidade do Porto, Portugal
| | - António Coelho
- Faculdade de Engenharia da Universidade do Porto, Portugal, INESC TEC - Instituto de Engenharia de Sistemas e Computadores, Tecnologia e Ciência, Portugal
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Mannino M, Sollena P, Esposito M, Fargnoli MC, Peris K, Nagore E. Self-Assessment Questionnaire on Patient-Physician Concordance on Nevus Self-Count and Models Development to Predict High-Risk Phenotype >50 Nevi. Dermatology 2022; 238:986-995. [PMID: 35462375 DOI: 10.1159/000523953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/26/2022] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Cutaneous melanoma accounts for the majority of skin cancer-related deaths. Readily identifiable phenotypic characteristics and total body nevus count (TBNC) >50 are among the most important risk factors for cutaneous melanoma. Implementation of nevus self-count procedures and self-assessment of phenotypic traits as part of skin self-examination could be an excellent screening tool for identifying an at-risk target population. OBJECTIVES Objectives of the study were to assess the skills of a central Italian and eastern Spanish population sample to recognize their skin lesions via the submission of a self-assessment questionnaire and to explore which self-assessment questionnaire item combination best predicts the high-risk condition of TBNC >50. METHODS Patients aged ≥18 years filled a self-assessment questionnaire, autonomously and prior to the dermatological visit. Subsequently, dermatologists performed total body skin examination and reported patients' skin lesions on a separate questionnaire. RESULTS We reported fair to moderate patient-dermatologist agreement for skin lesion self-assessment. The item number of nevi on the back was the single questionnaire item most accurately predicting TBNC >50. The high-sensitivity and high-specificity classification and regression tree models for the prediction of TBNC >50 displayed different items combinations; the item nevus on the back was always the first and most important predictor in both our models. CONCLUSIONS Patients were partially able to provide correct estimation of their whole-body nevus self-count. The item nevi on the back seems to be the first and most important predictor of TBNC >50 across our models. Delivery of high-sensitivity and high-specificity prediction models based on our questionnaire item combination may help defining a high-risk target population.
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Affiliation(s)
- Maria Mannino
- Institute of Dermatology, Catholic University, Rome, Italy
| | - Pietro Sollena
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ketty Peris
- Institute of Dermatology, Catholic University, Rome, Italy
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eduardo Nagore
- Department of Dermatology, Istituto Valenciano de Oncología, València, Spain
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Manne S, Heckman CJ, Kashy D, Ritterband L, Thorndike F, Lozada C, Coups EJ. Moderators of the Effects of mySmartSkin, a Web-Based Intervention to Promote Skin Self-examination and Sun Protection Among Individuals Diagnosed With Melanoma. Ann Behav Med 2022; 56:804-815. [PMID: 35028656 PMCID: PMC9345181 DOI: 10.1093/abm/kaab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Identifying the characteristics of persons who benefit more from behavioral interventions can help health care providers decide which individuals should be offered particular interventions because this is the subgroup of persons who are more likely to derive greater benefit from the intervention and refine the underlying constructs of the model guiding the intervention. PURPOSE This study evaluated possible demographic, medical, knowledge and attitudinal, and psychosocial variables that may moderate the impact of an online intervention, called mySmartSkin (MSS), on engagement in skin self-examination (SSE) and sun protection behaviors among melanoma survivors. METHODS Participants completed a baseline survey and were then randomized to the MSS condition or usual care. Follow-up surveys were completed by participants at 8-, 24-, and 48-week postrandomization. RESULTS A greater impact of MSS on SSE was illustrated among participants with more phenotypic skin cancer risk factors and participants reporting lower baseline self-efficacy in conducting SSE. A more favorable response of MSS on sun protection behaviors was shown when initial knowledge about abnormal lesions and sun protection barriers were high. Greater use of MSS and more favorable evaluations of it were also associated with higher intervention response. CONCLUSIONS Future studies seeking to improve SSE and sun protection among melanoma survivors might benefit from focusing on survivors who report more skin cancer risk factors, lower self-efficacy in conducting SSE, less knowledge about what abnormal skin lesions look like, more perceived barriers to sun protection behaviors, and less worry about recurrence and cancer-related distress.
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Affiliation(s)
| | - Carolyn J Heckman
- Department of Medicine, Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Deborah Kashy
- Michigan State University, Department of Psychology, East Lansing, MI, USA
| | - Lee Ritterband
- School of Medicine, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolina Lozada
- Department of Medicine, Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Jiyad Z, Plasmeijer EI, Keegan S, Samarasinghe V, Green AC, Akhras V. Defining the Validity of Skin Self-Examination as a Screening Test for the Detection of Suspicious Pigmented Lesions: A Meta-Analysis of Diagnostic Test Accuracy. Dermatology 2022; 238:640-648. [PMID: 34979506 DOI: 10.1159/000520592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skin self-examination (SSE) is widely promoted for the detection of suspicious pigmented lesions. However, determining screening accuracy is essential to appraising the usefulness of SSE. OBJECTIVES The aim of this work was to pool estimates from studies of SSE diagnostic accuracy in the detection of suspicious pigmented lesions. METHODS This study was registered with PROSPERO (CRD42021246356) and conducted in accordance with PRISMA-DTA guidelines. A systematic search of Medline (PubMed) EMBASE, CINAHL, and The Cochrane Library was conducted to identify relevant studies. We included studies that examined the accuracy of SSE, either whole-body or site-specific, for detecting change in individual pigmented lesions or detecting an atypical naevus. A univariate random-effects model, based on logit-transformed data, was used to calculate a summary diagnostic odds ratio (DOR) as well as pooled sensitivity and specificity. Cochran's Q test and the I2 statistic were calculated to assess heterogeneity. A proportional hazards model was used to calculate the area under the curve (AUC) and plot the summary receiver operator characteristic curve. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to grade study quality. RESULTS We identified 757 studies, of which 3 met inclusion criteria for quantitative synthesis. The pooled sensitivity and specificity based on 553 included participants was 59 and 82%, respectively. The summary DOR was 5.88 and the AUC was 0.71. There were some concerns regarding risk of bias in all 3 studies. CONCLUSIONS SSE can detect suspicious pigmented lesions with reasonable sensitivity and relatively high specificity, with the AUC suggesting acceptable discriminatory ability.
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Affiliation(s)
- Zainab Jiyad
- Department of Dermatology, St. George's Hospital, London, UK
- Population Health Research Institute, St. George's University of London, London, UK
| | | | - Samantha Keegan
- Department of Dermatology, St. George's Hospital, London, UK
| | | | - Adele C Green
- Department of Population Health, QIMR Berghofer, Brisbane, Queensland, Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Victoria Akhras
- Department of Dermatology, St. George's Hospital, London, UK
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Robinson JK, Wahood S, Ly S, Kirk J, Yoon J, Sterritt J, Gray E, Kwasny M. Melanoma detection by skin self-examination targeting at-risk women: A randomized controlled trial with telemedicine support for concerning moles. Prev Med Rep 2021; 24:101532. [PMID: 34976609 PMCID: PMC8683880 DOI: 10.1016/j.pmedr.2021.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 12/04/2022] Open
Abstract
Secondary melanoma prevention remains crucial to reduce morbidity and mortality for the 200,000 people in the United States estimated to develop melanoma in 2021. This 3-month randomized controlled trial of online skin self-examination (SSE) education among 1000 at-risk women who received care at Northwestern Medicine in Illinois sought to determine SSE initiation and monthly performance, SSE anxiety and confidence, and health care practitioner (HCP) visits for concerning moles. Positive responses to a personal history of sunburn, a personal or family history of skin cancer, and/or having 10 or more lifetime indoor tanning sessions identified and informed women of their increased risk of melanoma. At one month, 96.2% of women receiving SSE education (SSE women) initiated SSE compared to 48.1% in the active control arm (control) (p < 0.001). More control women sought HCP visits (n = 107) than SSE women (n = 39). Control women seen by HCPs identified benign lesions, especially seborrheic keratosis, more often than SSE women. More atypical nevi (SSE 38.5%, control 8.4%) and melanomas (SSE 25.6%, control 4.7%) were visually identified by SSE women seeing HPCs (p < 0.001). There was no significant difference in SSE anxiety between the control and SSE arms. Confidence increased significantly in the SSE arm whereas there was no change in the control group (p < 0.001). Women checked someone else for concerning moles [315/ 494 (63.8%) of SSE women]. Targeting at-risk women for SSE education may help reduce melanoma mortality, especially in rural communities where incidence and mortality are greater than in urban areas.
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Affiliation(s)
- June K. Robinson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Samer Wahood
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sophia Ly
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jessie Kirk
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jamie Yoon
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - James Sterritt
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Manne SL, Heckman CJ, Kashy DA, Ritterband LM, Thorndike FP, Lozada C, Coups EJ. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection among individuals diagnosed with melanoma. Transl Behav Med 2021; 11:1461-1472. [PMID: 33904921 DOI: 10.1093/tbm/ibaa103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adherence to regular, thorough skin self-examination (SSE) and consistent sun protection behaviors among melanoma survivors is relatively low. This study reports on the impact of an online intervention, called mySmartSkin (MSS), on engagement in SSE and sun protection behaviors among melanoma survivors, as well as the mediators of the intervention effects. The intervention was compared with usual care (UC), and primary outcomes were assessed at 24 and 48 weeks. Short-term outcomes were also evaluated at 8 weeks postbaseline. Results demonstrate a significant effect on SSE and sun protection. At all three follow-up assessments, the proportion of participants reporting conducting a thorough SSE in the time since the previous assessment was significantly greater in MSS than in UC. In addition, both multivariate and univariate analyses indicated that engagement in sun protection behaviors was significantly higher in MSS than UC at 24 weeks, but the effect on sun protection at 48 weeks was significant only in multivariate analyses. Beneficial effects of MSS were significantly mediated by knowledge about melanoma and characteristics of suspicious lesions, as well as self-efficacy. Participant engagement in MSS was satisfactory, with approximately two-thirds of participants completing at least two of the three core components. Content was rated as highly trusted, easy to understand, easy to navigate, and helpful. In conclusion, MSS illustrated significant and durable effects on SSE and mixed results on sun protection. Future studies should consider ways to further enhance treatment effects and engagement in MSS.
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Affiliation(s)
- Sharon L Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Deborah A Kashy
- Michigan State University, Department of Psychology, East Lansing, MI, USA
| | - Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Center for Behavioral Health & Technology, Charlottesville, VA, USA
| | - Frances P Thorndike
- Department of Psychiatry and Neurobehavioral Sciences, Pear Therapeutics, Boston, MA, USA
| | - Carolina Lozada
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Robinson JK, Brown Z, Spring B. Melanoma Skin Self-Examination Education During Mammography: Health Burden of Women Impairs Implementation. J Cancer Educ 2021; 36:858-864. [PMID: 32090289 PMCID: PMC7483150 DOI: 10.1007/s13187-020-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. In this sequential mixed methods research, interviews with women who found a concerning mole and did not have health-care follow-up were analyzed and a survey was created. One year after SSE education, barriers to having health care for a self-identified concerning mole were assessed. The electronic medical records for all participants, who received education, were reviewed to ascertain who received health care related to a concerning mole or a screening mammogram. Among the 280 women who performed SSE, 85 found a concerning mole. Nine months later 51 women did not receive health care for the mole. Barriers were the burden of other medical concerns, fear of what the doctor will find, feeling like nothing is wrong, and being too busy. A positive screening mammogram (Fisher's two-sided exact test, p < 0.001) and a history of indoor tanning (Fisher's two-sided exact test, p = 0.011) were significantly associated with lack of follow-up for a concerning mole. Targeted melanoma self-identification with SSE relies upon participants initiating performance and seeking medical care for a concerning mole. The burden of a positive screening mammogram reported to women at about the same time as they identified the concerning mole was associated with failing to seek care for their concerning mole. Reminders to check moles for change 4 months after identifying a concerning mole may benefit women. Clinicaltrials.gov NCT03512457.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA.
| | - Zoe Brown
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Koh U, Betz-Stablein B, O'Hara M, Horsham C, Curiel-Lewandrowski C, Soyer HP, Janda M. Development of a Checklist Tool to Assess the Quality of Skin Lesion Images Acquired by Consumers Using Sequential Mobile Teledermoscopy. Dermatology 2021; 238:27-34. [PMID: 33849022 DOI: 10.1159/000515158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mobile teledermoscopy is an emerging technology that involves imaging and digitally sending dermoscopic images of skin lesions to a clinician for assessment. High-quality, consistent images are required for accurate telediagnoses when monitoring lesions over time. To date there are no tools to assess the quality of sequential images taken by consumers using mobile teledermoscopy. The purpose of this study was to develop a tool to assess the quality of images acquired by consumers. METHODS Participants imaged skin lesions that they felt were concerning at baseline, 1-, and 2-months. A checklist to assess the quality of consumer sequential imaging of skin lesions was developed based on the International Skin Imaging Collaboration guidelines. A scale was implemented to grade the quality of the images: 0 (low) to 18 (very high). Intra- and inter-reliability of the checklist was assessed using Bland-Altman analysis. Using this checklist, the consistency with which 85 sets of images were scored by 2 evaluators were compared using Kappa statistics. Items with a low Kappa value <0.4 were removed. RESULTS After reliability testing, 5 of the items were removed due to low Kappa values (<0.4) and the final checklist included 13 items surveying: lesion selection; image orientation; lighting; field of view; focus and depth of view. Participants had a mean age of 41 years (range 19-73), and 67% were female. Most participants (84%, n = 71/85) were able to select and image the correct lesion over time for both the dermoscopic and overview images. Younger participants (<40 years old) scored significantly higher (8.1 ± 2.1) on the imaging checklist compared to older participants (7.1 ± 2.4; p = 0.037). Participants had most difficulty with consistent image orientation. CONCLUSIONS This checklist could be used as a triage tool to filter images acquired by consumers prior to telediagnosis evaluation, which would improve the efficiency and accuracy of teledermatology and teledermoscopy processes. It may also be used to provide feedback to the consumers to improve image acquisition over time.
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Affiliation(s)
- Uyen Koh
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Brigid Betz-Stablein
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Montana O'Hara
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Clara Curiel-Lewandrowski
- Department of Dermatology and the University of Arizona Cancer Center Skin Cancer Institute, University of Arizona, Tucson, Arizona, USA
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Torrecilla-Martínez I, Manrique-Silva E, Traves V, Requena C, Nagore E. Adherence to Primary Prevention and Skin Self-Examination Practices by Spanish Melanoma Patients. Dermatology 2021; 237:1016-1022. [PMID: 33465771 DOI: 10.1159/000512887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma, an important global public health problem, has been increasing over the last several decades. OBJECTIVES In order to decrease melanoma-related mortality, ways to communicate and implement the correct methods for conducting primary and secondary prevention measures (such as early detection via self-examination) should be investigated. MATERIALS AND METHODS An observational, cross-sectional, retrospective study consisting of 409 patients diagnosed with cutaneous melanoma was conducted. An online questionnaire was created to evaluate knowledge levels, attitudes, and adherence to primary preventive measures and to skin self-examination practices. RESULTS The results revealed that even when 43% of the patients perform cutaneous self-examinations, only half of them fully followed the recommendations. Patients aged <45 years, female, with a I-II phototype, with an intermediate/high level of education, and with a history of NMSC were more likely to have an adequate degree of knowledge. Moreover, patients aged <45 years and with an adequate degree of knowledge more frequently showed an adequate adherence to the primary prevention measures. Finally, patients aged 45-60 years and with an adequate degree of knowledge presented a good adherence to the self-skin examination measures. LIMITATIONS Possible limitations of this study were memory bias through the influence of age within the study population, and bias due to a greater proportion of subjects with a high education level. CONCLUSION Within the population of patients with melanoma, a high percentage of patients do not rigorously follow the recommended prevention measures. Our study highlights the need to implement awareness in this population to improve the prevention of cutaneous cancer.
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Affiliation(s)
| | - Esperanza Manrique-Silva
- Escuela de Doctorado, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Victor Traves
- Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain,
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Zehra Altunkurek S, Kaya E. Parents' knowledge and understanding of skin cancer and skin self-examination and behaviors to protect their children from the sun. Eur J Oncol Nurs 2021; 50:101884. [PMID: 33429351 DOI: 10.1016/j.ejon.2020.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/01/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to determine parents' knowledge of skin cancer and skin self-examination (SSE) and their efforts to protect their school aged children from the sun. METHODS This cross-sectional study was conducted between November 2018 and November 2019 in Turkey with 1004 parents of middle school students. RESULTS Of the parents, 53.7% did not have knowledge about skin cancer or SSE, and 76% did not conduct SSEs with their 9-14 years old children. A total of 61.3% of the participants prevented their children from standing in the sun, but 56.1% did not apply sunscreen to their children. The total mean score on the Skin Cancer and Sun Knowledge Scale (SCSKS) was 13.16 ± 3.03. There were significant differences in the total SCSKS scores by parental gender, number of children, education level, economic status, use of sunscreen, frequency of application of sunscreen, use of light-colored clothing, prevention of exposure to sunlight, use of sunglasses outside, knowledge about skin cancer and SSE and knowledge about early diagnosis of skin cancer (p < 0.05). CONCLUSION This study showed that parents' behaviors related to sun protection and their skin cancer and SSE knowledge levels were not sufficient. In schools, both students and parents should receive health education regarding skin cancer and prevention methods.
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Affiliation(s)
- Serife Zehra Altunkurek
- Public Health Nursing Department, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey.
| | - Eylül Kaya
- Public Health Nursing Department, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey.
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12
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Bhurosy T, Heckman CJ, Riley M. Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review. Transl Behav Med 2020; 10:1120-1133. [PMID: 33044529 DOI: 10.1093/tbm/ibaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).
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Affiliation(s)
- Trishnee Bhurosy
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mary Riley
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Armenian SH, Lindenfeld L, Iukuridze A, Echevarria M, Bebel S, Coleman C, Nakamura R, Abdullah F, Modi B, Oeffinger KC, Emmons KM, Marghoob AA, Geller AC. Technology-enabled activation of skin cancer screening for hematopoietic cell transplantation survivors and their primary care providers (TEACH). BMC Cancer 2020; 20:721. [PMID: 32746799 PMCID: PMC7397711 DOI: 10.1186/s12885-020-07232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies. However, HCT-related factors, such as total body irradiation used for conditioning, graft-versus-host disease, and prolonged exposure to immunosuppressive therapy, result in very high risk for melanoma and non-melanoma skin cancer (NMSC). In fact, skin cancer is the most common subsequent neoplasm in HCT survivors, tending to develop at a time when survivors' follow-up care has largely transitioned to the primary care setting. The goal of this study is to increase skin cancer screening rates among HCT survivors through patient-directed activation alone or in combination with physician-directed activation. The proposed intervention will identify facilitators of and barriers to risk-based screening in this population and help reduce the burden of cancer-related morbidity after HCT. METHODS/DESIGN 720 HCT survivors will be enrolled in this 12-month randomized controlled trial. This study uses a comparative effectiveness design comparing (1) patient activation and education (PAE, N = 360) including text messaging and print materials to encourage and motivate skin examinations; (2) PAE plus primary care physician activation (PAE + Phys, N = 360) adding print materials for the physician on the HCT survivors' increased risk of skin cancer and importance of conducting a full-body skin exam. Patients on the PAE + Phys arm will be further randomized 1:1 to the teledermoscopy (PAE + Phys+TD) adding physician receipt of a portable dermatoscope to upload images of suspect lesions for review by the study dermatologist and an online course with descriptions of dermoscopic images for skin cancers. DISCUSSION When completed, this study will provide much-needed information regarding strategies to improve skin cancer detection in other high-risk (e.g. radiation-exposed) cancer survivor populations, and to facilitate screening and management of other late effects (e.g. cardiovascular, endocrine) in HCT survivors. TRIAL REGISTRATION ClinicalTrials.gov, NCT04358276 . Registered 24 April 2020.
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Affiliation(s)
- Saro H. Armenian
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Lanie Lindenfeld
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Aleksi Iukuridze
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Meagan Echevarria
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Samantha Bebel
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Catherine Coleman
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA USA
| | | | - Badri Modi
- Department of Surgery, City of Hope, Duarte, CA USA
| | - Kevin C. Oeffinger
- Department of Medicine, Community and Family Medicine and Population Health Sciences, Duke Cancer Institution, Duke, North Carolina USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Ashfaq A. Marghoob
- Department of Dermatology, Memorial-Sloan Kettering Cancer Center, New York, NY USA
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA USA
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14
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Coroiu A, Moran C, Bergeron C, Drapeau M, Wang B, Kezouh A, Ernst J, Batist G, Körner A. Short and long-term barriers and facilitators of skin self-examination among individuals diagnosed with melanoma. BMC Cancer 2020; 20:123. [PMID: 32059700 PMCID: PMC7023754 DOI: 10.1186/s12885-019-6476-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Melanoma can be lethal if not detected early and treated. Early detection can be facilitated via skin self-examination (SSE) and as such, SSE is part of melanoma follow-up care for individuals with a prior history, who face a life-long risk of reoccurrence. The objective of the current study was to identify short- and long-term predictors of SSE among melanoma survivors to inform future prevention interventions in high-risk groups. Method This is an observational study with longitudinal assessments conducted with adult melanoma patients in active follow-up care. Primary outcome measures Behavioral outcomes, comprehensive SSE (checking up to 5 body areas in the last 3 months) and optimal SSE (checking the entire body at least monthly in the last 3 months) were assessed at 3, 12, and 24 months post a dermatological educational session on skin cancer prevention. T tests and chi square analyses were used to examine changes in outcomes from 3 to 12 and 24 months. Linear and logistic regression models were used to examine the association between predictors and the primary outcomes. Results Comprehensive SSE did not decrease significantly from 3 (M = 2.7, SD = 1.1) to 12 (M = 2.6, SD = 1.2) and 24 months (M = 2.4, SD = 1.2) post the education session, with the stronger predictor at all timepoints being intentions to perform SSE. Optimal SSE was higher at 3 months (59%) compared to 12 (46%) and 24 months (34%), with key predictors including self-efficacy and intentions to perform SSE and male sex at 3 months post; self-efficacy and reliance on medical advice at 12 months; and (lower) education and self-efficacy at 24 months. Conclusions The key findings of this study are that 1) survivors maintain SSE behaviour over time, but rates of SSE performed in agreement with medical recommendations are higher immediately post standard dermatological education (i.e. usual care) and decrease somewhat over a 24-month period; and 2) the strongest psycho-social predictors of SSE are intentions and self-efficacy to perform the behavior, which are highly modifiable, for example via motivational interviewing and goal setting health interventions.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Martin Drapeau
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.,Department of Psychiatry, McGill University, Montréal, Canada
| | - Beatrice Wang
- Gerald Bronfman Department of Oncology, McGill University Health Center, Montréal, Canada
| | - Abbas Kezouh
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
| | - Gerald Batist
- Department of Medicine, McGill University, Montréal, Canada.,Department of Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Canada.,Department of Oncology, McGill University, Montréal, Canada.,Segal Cancer Centre, Montréal, Canada.,Centre for Translational Research in Cancer, McGill University, Montréal, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.,Department of Oncology, McGill University, Montréal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada.,Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Montreal, Canada.,Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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15
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Cheng BT. Mammography is an opportunity to promote melanoma education in women. Prev Med 2020; 133:106027. [PMID: 32057957 DOI: 10.1016/j.ypmed.2020.106027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/26/2020] [Accepted: 02/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Brian T Cheng
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America.
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16
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Hubbard G, Cherrie J, Gray J, Kyle RG, Nioi A, Wendelboe-Nelson C, Cowie H, Dombrowski S. Sun protection education for adolescents: a feasibility study of a wait-list controlled trial of an intervention involving a presentation, action planning, and SMS messages and using objective measurement of sun exposure. BMC Public Health 2020; 20:131. [PMID: 32000743 PMCID: PMC6990594 DOI: 10.1186/s12889-020-8265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People increase their risk of melanoma unless they are protected from the harmful effects of sun exposure during childhood and adolescence. We aimed to assess the feasibility of a three-component sun protection intervention- presentation, action planning, and SMS messages - and trial parameters. METHODS This feasibility wait-list trial was conducted in the United Kingdom in 2018. Students aged 13-15 years were eligible. Feasibility outcomes were collected for recruitment rates; data availability rates for objective measurements of melanin and erythema using a Mexameter and self-reported sunburn occurrences, severity and body location, tanning, sun protection behaviours and Skin Self-Examination (SSE) collected before (baseline) and after the school summer holidays (follow-up); intervention reach, adherence, perceived impact and acceptability. Quantitative data were analysed using descriptive statistics; qualitative data were analysed thematically. RESULTS Five out of eight schools expressing an interest in participating with four allocated to act as intervention and one control. Four parents/carers opted their child out of the study. Four hundred and eighty-seven out of 724 students on the school register consented to the study at baseline (67%). Three hundred and eighty-five were in intervention group schools. Objective skin measurements were available for 255 (66%) of the intervention group at baseline and 237 (61%) of the group at follow up. Melanin increased; erythema decreased. Complete self-report data were available for 247 (64%) students in the intervention group. The number of students on the school register who attended the presentation and given the booklet was 379 (98%) and gave their mobile phone number was 155 (40%). No intervention component was perceived as more impactful on sun protection behaviours. Adolescents did not see the relevance of sun protection in the UK or for their age group. CONCLUSIONS This is the first study to use a Mexameter to measure skin colour in adolescents. Erythema (visible redness) lasts no more than three days and its measurement before and after a six week summer holiday may not yield relevant or meaningful data. A major challenge is that adolescents do not see the relevance of sun protection and SSE. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN11141528. Date registered 0/2/03/2018; last edited 31/05/2018. Retrospectively registered.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| | - John Cherrie
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
- Research Division, Institute of Occupational Medicine, Edinburgh, EH14 4AP UK
| | - Jonathan Gray
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| | - Richard G. Kyle
- School of Health & Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Amanda Nioi
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
| | - Charlotte Wendelboe-Nelson
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, EH14 3AS UK
| | - Hilary Cowie
- Research Division, Institute of Occupational Medicine, Edinburgh, EH14 4AP UK
| | - Stephan Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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17
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Coups EJ, Manne SL, Ohman Strickland P, Hilgart M, Goydos JS, Heckman CJ, Chamorro P, Rao BK, Davis M, Smith FO, Thorndike FP, Ritterband LM. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection behaviors among individuals diagnosed with melanoma: study design and baseline characteristics. Contemp Clin Trials 2019; 83:117-127. [PMID: 31255801 PMCID: PMC6690854 DOI: 10.1016/j.cct.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948.
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Affiliation(s)
- Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Michelle Hilgart
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Paola Chamorro
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Moira Davis
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | - Franz O Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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18
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Bergeron C, Moran C, Coroiu A, Körner A. Development and initial validation of the Self-Efficacy for Skin Self-Examination Scale in a Canadian sample of patients with melanoma. Eur J Oncol Nurs 2019; 40:78-84. [PMID: 31229210 DOI: 10.1016/j.ejon.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Melanoma is the deadliest type of skin cancer, although survival rates are high if detected early. Skin self-examination (SSE) is a health behaviour that can lead to early detection of melanoma and more positive health outcomes. Self-efficacy for SSE is a potential predictor of engaging in skin self-exams. However, no standardized measures of self-efficacy for SSE are currently available. The present study reports on the development and initial validation of a measure assessing self-efficacy for SSE. METHOD Based on a literature review, including previous studies assessing this construct, the research team developed 9 items capturing confidence in one's ability to conduct SSE. Items were subsequently revised by the research team and two dermatologists, resulting in the elimination of 4 items and modifications to the response options. The final 5-item Self-Efficacy for SSE scale was administered to a sample of 242 melanoma patients recruited from local hospitals. We assessed the scale's factor structure through exploratory factor analysis and the internal consistency with Cronbach's alpha. Scale scores were correlated with intentions to perform SSE, physician support for SSE, skin cancer-specific distress, general distress, and sociodemographic variables to assess convergent and divergent validity. RESULTS The scale was found to be unifactorial with adequate model fit, have acceptable internal consistency (Cronbach alpha = 0.74), and initial evidence of convergent and divergent validity, as indicated by the scale correlating with physicians' support for SSE (r = 0.30, p < 0.01), intention to perform SSE (rs = 0.21, p < 0.01) and a weak correlation with general distress (r = 0.15, p < 0.05). CONCLUSIONS Pending future research corroborating these findings, this measure has potential for use by nurses and other health professionals in follow-up care to identify individuals at risk for low self-efficacy for SSE requiring more targeted educational SSE interventions.
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Affiliation(s)
- Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Adina Coroiu
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada; Department of Oncology, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Montreal, Canada; Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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19
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Hubbard G, Kyle RG, Neal RD, Marmara V, Wang Z, Dombrowski SU. Promoting sunscreen use and skin self-examination to improve early detection and prevent skin cancer: quasi-experimental trial of an adolescent psycho-educational intervention. BMC Public Health 2018; 18:666. [PMID: 29843654 PMCID: PMC5975556 DOI: 10.1186/s12889-018-5570-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Skin cancer rates are increasing. Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required. Methods Quasi-experimental design; 1 control and 4 intervention group schools in Scotland, UK. Participants were 15–16 year old students on the school register. The intervention was a theoretically-informed (Common-Sense Model and Health Action Process Approach) 50-min presentation, delivered by a skin cancer specialist nurse and young adult skin cancer survivor, to students in a classroom, supplemented by a home-based assignment. Outcome variables were sunscreen use intention, SSE intention/behaviour, planning, illness perceptions and skin cancer communication behaviour, measured 2 weeks pre- and 4 weeks post- intervention using self-completed pen and paper survey. School attendance records were used to record intervention up-take; students self-reported completion of the home-based assignment. Pearson’s chi-square test, analysis of variance, and non-parametric Wilcoxon Signed Ranks Test were used to measure outcomes and associations between variables. Focus groups elicited students’ (n = 29) views on the intervention. Qualitative data were analysed thematically. Results Five of 37 invited schools participated. 639 (81%) students in intervention schools received the intervention; 33.8% completed the home-based assignment. 627 (69.6%) of students on the school register in intervention and control schools completed a questionnaire at baseline; data for 455 (72.6%) students were available at baseline and follow-up. Focus groups identified four themes – personal experiences of skin cancer, distaste for sunscreen, relevance of SSE in adolescence, and skin cancer conversations. Statistically significant (p < 0.05) changes were observed for sunscreen use, SSE, planning, and talk about skin cancer in intervention schools but not the control. Significant associations were found between sunscreen use, planning and 2 illness perceptions (identity and consequence) and between SSE, planning and 3 illness perceptions (timeline, causes, control). Conclusions It is feasible to promote sunscreen use and SSE in the context of an adolescent school-based psychoeducation intention. Further research is required to improve study uptake, intervention adherence and effectiveness. Trial registration ISRCTN11141528 Electronic supplementary material The online version of this article (10.1186/s12889-018-5570-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gill Hubbard
- School of Health, Social Care and Life Sciences, Centre for Health Sciences, University of the Highlands and Islands (UHI), Old Perth Road, Inverness, IV2 3JH, Scotland.
| | - Richard G Kyle
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Richard D Neal
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Vincent Marmara
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Humanities B (FEMA), Msida, MSD, 2080, Malta
| | - Ziyan Wang
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
| | - Stephan U Dombrowski
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
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Gaber R, Mallett KA, Hultgren B, Turrisi R, Gilbertsen ML, Martini MC, Robinson JK. Enhanced fidelity of an educational intervention on skin self-examination through surveillance and standardization. J Nurs Educ Pract 2014; 4:253-258. [PMID: 25414761 DOI: 10.5430/jnep.v4n2p253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Melanoma can metastasize but is often successfully treated when discovered in an early stage. Melanoma patients and their skin check partners can learn skin self-examination (SSE) skills and these skills can be improved by practice. The purpose of this study is to determine the degree of fidelity with which educational in-person SSE intervention can be delivered by trained research coordinators to patients at risk of developing another melanoma and their skin check partners. METHODS The in-person intervention was performed in two iterations. In phase 1 (2006-2008), the research coordinators were trained to perform the intervention using a written script. In phase 2 (2011-2013), the research coordinators were trained to perform the intervention with a PowerPoint aid. Each research coordinator was individually counseled by one of the authors (KM) to insure standardization and enhance fidelity of intervention delivery. Phase 1 and Phase 2 were compared on 16 fidelity components. Further, Phase 2 fidelity was assessed by comparing mean scores of fidelity across the five research coordinators who delivered the intervention. RESULTS Phase 2, which utilized a PowerPoint aid, was delivered with a higher degree of fidelity compared to phase 1with four fidelity components with significantly higher fidelity than Phase 1: 1) Explained details of melanoma, χ2 (1, n = 199)= 96.31, p < .001, 2) Discussed when to call doctor, χ2 (1, n = 199) = 53.68, p < .001 3) Explained assessment at month 1, χ2 (1, n = 199)= 12.39, p < .01, and 4) Explained assessment at month 2, χ2 (1, n = 199) = 117.75, p < .001. Further, no significant differences on mean fidelity were found across research coordinators in Phase 2. DISCUSSION When using the PowerPoint aide, the research coordinators delivered the intervention with high fidelity (all scores >14) and there were no mean differences in fidelity across research coordinators, indicating consistency in fidelity. This can be attributed to the standardization and cueing that the PowerPoint program offered. Supervision was also a key component in establishing and maintaining fidelity of the patient educational process. This method of intervention delivery enables trained healthcare professionals to deliver an educational intervention in an effective, consistent manner.
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Affiliation(s)
- Rikki Gaber
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kimberly A Mallett
- Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA
| | - Brittney Hultgren
- Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA
| | - Rob Turrisi
- Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA
| | | | - Mary C Martini
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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King AJ, Gehl RW, Grossman D, Jensen JD. Skin self-examinations and visual identification of atypical nevi: comparing individual and crowdsourcing approaches. Cancer Epidemiol 2013; 37:979-84. [PMID: 24075797 DOI: 10.1016/j.canep.2013.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Skin self-examination (SSE) is one method for identifying atypical nevi among members of the general public. Unfortunately, past research has shown that SSE has low sensitivity in detecting atypical nevi. The current study investigates whether crowdsourcing (collective effort) can improve SSE identification accuracy. Collective effort is potentially useful for improving people's visual identification of atypical nevi during SSE because, even when a single person has low reliability at a task, the pattern of the group can overcome the limitations of each individual. METHODS Adults (N=500) were recruited from a shopping mall in the Midwest. Participants viewed educational pamphlets about SSE and then completed a mole identification task. For the task, participants were asked to circle mole images that appeared atypical. Forty nevi images were provided; nine of the images were of nevi that were later diagnosed as melanoma. RESULTS Consistent with past research, individual effort exhibited modest sensitivity (.58) for identifying atypical nevi in the mole identification task. As predicted, collective effort overcame the limitations of individual effort. Specifically, a 19% collective effort identification threshold exhibited superior sensitivity (.90). CONCLUSIONS The results of the current study suggest that limitations of SSE can be countered by collective effort, a finding that supports the pursuit of interventions promoting early melanoma detection that contain crowdsourced visual identification components.
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Affiliation(s)
- Andy J King
- College of Media & Communication, Texas Tech University, United States.
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