Körner Annett, Drapeau Martin, Thombs Brett D, Rosberger Zeev, Wang Beatrice, Khanna Manish, Spatz Alan, Coroiu Adina, Garland Rosalind, Batist Gerald
Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada.
BMC Dermatol. 2013 Mar 1;13:3. doi: 10.1186/1471-5945-13-3.
Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology.
METHODS/DESIGN: The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings.
The identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.
黑色素瘤是皮肤中增长最快的肿瘤，对年轻人和中年人影响尤为严重。由于黑色素瘤在早期阶段是可见的、可识别的且治愈率很高，早期诊断是降低黑色素瘤相关死亡率的最有效措施之一。皮肤自我检查可实现黑色素瘤的早期发现和切除。由于黑色素瘤幸存者患后续黑色素瘤的风险增加，强烈建议将每月自我检查作为后续护理的一部分。然而，只有少数高危个体进行系统且定期的自我检查。这一点可通过患者教育得到改善。然而，皮肤病学教育仅在约50%的病例中有效，对于那些没有反应的人知之甚少。在当前文献中，尽管心理社会变量如痛苦、应对癌症以及伴侣和医生的支持已被证明对其他健康行为和遵守医疗建议至关重要，但在皮肤自我检查的实践方面却被广泛忽视。此外，当前的知识体系因皮肤自我检查（SSE）概念的不一致而受到影响。本项目的主要目标是使用严谨且临床合理的方法研究皮肤自我检查的心理社会预测因素。
方法/设计：这项纵向混合方法研究考察了200名黑色素瘤患者中与皮肤自我检查的习得和长期维持相关的关键心理社会变量。在接受基于最佳实践标准设计的教育干预后3个月和12个月评估自我检查行为的实践情况。考察的皮肤自我检查行为预测因素包括生物性别、自我检查效能感、痛苦、伴侣和医生的支持以及应对策略。对半结构化访谈的定性分析将补充并阐明定量研究结果。
确定皮肤自我检查的短期和长期预测因素以及对障碍的更多了解将使医疗保健专业人员能够更好地解决患者在坚持这种挽救生命的健康行为方面的困难。此外，研究结果将有助于制定和评估基于证据的综合干预策略。最终，这些发现可能会影响针对其他黑色素瘤风险增加人群的广泛外展项目和二级预防举措。
