Department of General Practice, Faculty of Medicine of Nantes, France.
Ann Fam Med. 2014 Jan-Feb;12(1):21-8. doi: 10.1370/afm.1600.
Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior.
We conducted a pilot clustered randomized controlled trial, comparing a targeted screening and education intervention with a conventional information-based campaign in 20 private surgeries in western France. In the intervention group, 10 general practitioners identified patients at elevated risk for melanoma with a validated assessment tool, the Self-Assessment Melanoma Risk Score (SAMScore), examined their skin, and counseled them using information leaflets. In the control group, 10 general practitioners displayed a poster and the leaflets in their waiting room and examined patients' skin at their own discretion. The main outcome measures were sunbathing and skin self-examinations among patients at elevated risk, assessed 5 months later with a questionnaire.
Analyses were based on 173 patients. Compared with control patients, intervention patients were more likely to remember the campaign (81.4% vs 50.0%, P = .0001) and to correctly identify their elevated risk of melanoma (71.1% vs 42.1%, P = .001). Furthermore, intervention patients had higher levels of prevention behaviors: they were less likely to sunbathe in the summer (24.7% vs 40.8%, P = .048) and more likely to have performed skin self-examinations in the past year (52.6% vs 36.8%, P = .029). The intervention was not associated with any clear adverse effects, although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease.
The combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.
针对降低黑色素瘤风险和提高早期检测率的目标干预措施有可能挽救生命。我们旨在评估此类干预措施对患者预防行为的影响。
我们进行了一项试点性聚类随机对照试验，在法国西部的 20 家私人诊所中，比较了靶向筛查和教育干预与传统基于信息的活动。在干预组中，10 名全科医生使用经过验证的评估工具（自我评估黑色素瘤风险评分，SAMScore）识别出患有黑色素瘤风险升高的患者，检查他们的皮肤，并使用信息传单对他们进行咨询。在对照组中，10 名全科医生在候诊室展示海报和传单，并自行检查患者的皮肤。主要结局指标是 5 个月后通过问卷评估的高风险患者的日光浴和皮肤自我检查情况。
分析基于 173 名患者。与对照组患者相比，干预组患者更有可能记住该活动（81.4%比 50.0%，P =.0001），并正确识别其黑色素瘤风险升高（71.1%比 42.1%，P =.001）。此外，干预组患者的预防行为水平更高：他们在夏季日光浴的可能性较低（24.7%比 40.8%，P =.048），过去一年中进行皮肤自我检查的可能性较高（52.6%比 36.8%，P =.029）。该干预措施与任何明确的不良影响无关，尽管存在一些趋势，即干预组患者更有可能担心黑色素瘤，并再次向他们的全科医生咨询该疾病。
在咨询期间使用 SAMScore 和全科医生检查和咨询相结合，是促进可能降低黑色素瘤风险的患者行为的有效方法。延长随访时间并证明对发病率和死亡率的影响仍然是进一步研究的主要问题。
