Loescher Lois J, Harris John M, Curiel-Lewandrowski Clara
The University of Arizona, Tucson, 85721-0203, USA.
J Am Acad Nurse Pract. 2011 Dec;23(12):667-73. doi: 10.1111/j.1745-7599.2011.00659.x. Epub 2011 Aug 5.
Little is known about the skin cancer detection skills of advanced practice nurses (APNs). This systematic review of published literature seeks to describe (a) barriers to APNs' performance of skin examination, (b) APNs' ability to recognize suspicious skin lesions, and (c) APNs' skin cancer detection training activities.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the literature search (OVID Medline, Web of Science, and CINAHL databases) and interpretation of findings. Of the 136 articles meeting criteria for selection, 12 pertaining to the purpose were selected for further review.
Barriers to skin examination by APNs have been infrequently and inconsistently measured. Limited time to conduct skin examination is the most consistent barrier. APNs' ability to recognize and refer suspicious and benign lesions is inconsistent, but shows improvement after training. Few skin cancer training programs are available for APNs.
Larger and more rigorously designed studies are needed to better determine APNs' barriers and facilitators to skin cancer assessment and their ability to recognize and appropriately refer potentially malignant skin lesions with a high level of sensitivity and specificity. Training to increase these skills needs to be targeted to APNs and occur at a much higher volume than current efforts.
对于高级执业护士（APN）的皮肤癌检测技能了解甚少。本对已发表文献的系统综述旨在描述：（a）APN进行皮肤检查的障碍；（b）APN识别可疑皮肤病变的能力；（c）APN的皮肤癌检测培训活动。
系统评价与Meta分析的首选报告项目声明指导了文献检索（OVID Medline、科学网和CINAHL数据库）及结果解读。在符合入选标准的136篇文章中，选取了12篇与研究目的相关的文章进行进一步综述。
对APN进行皮肤检查的障碍的测量较少且不一致。进行皮肤检查的时间有限是最一致的障碍。APN识别和转诊可疑及良性病变的能力不一致，但培训后有所提高。针对APN的皮肤癌培训项目很少。
需要进行更大规模、设计更严谨的研究，以更好地确定APN在皮肤癌评估方面的障碍和促进因素，以及他们以高灵敏度和特异性识别并适当转诊潜在恶性皮肤病变的能力。提高这些技能的培训需要针对APN，且培训规模要比目前的努力大得多。
