Hultgren Brittney A, Turrisi Rob, Mallett Kimberly A, Ackerman Sarah, Robinson June K
Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park.
Prevention Research Center, The Pennsylvania State University, University Park.
JAMA Dermatol. 2016 Feb;152(2):184-90. doi: 10.1001/jamadermatol.2015.2819.
Melanoma has a high survival rate if it is detected early. Training patients with early-stage melanoma who are at risk of developing new melanomas to perform skin self-examination (SSE) may improve survival.
To examine for whom the intervention works best in a sample composed of dyads of patients with melanoma and skin-check partners who received an SSE intervention vs customary care.
DESIGN, SETTING, AND PARTICIPANTS: For 494 patients with stage 0 to IIB melanoma (mean age, 55 years; 253 [51.2%] females) and their skin-check partners (mean age, 55 years; 280 [56.7%] females), a randomized clinical trial was conducted in ambulatory care dermatologic offices from June 6, 2011, to April 14, 2014. Follow-up assessments were performed at 12 months. Analysis was performed between March 23 and June 25, 2015.
Dyads of 494 patients and their partners were randomly assigned to receive the intervention (395 patients) or customary care (control) (99 patients). The main outcome was patient SSE self-efficacy. Partner motivation to assist with SSE and relationship quality (eg, agreeability, activities with partner, and happiness) were assessed for moderation of the influence of the intervention's effect on SSE self-efficacy.
Relationship quality, defined by activities with the partner (β = -0.892, SE = 0.432, t = -2.066; P = .001) and happiness (β = -4.586, SE = 2.044, t = -2.24; P = .001), significantly moderated the intervention effects on patients' SSE self-efficacy. In contrast, patient-partner agreeability (β = -0.262, SE = 0.148, t = -1.773; P = .09) and partner motivation (β = -0.328, SE = 1.024, t = -0.320; P = .10) did not significantly moderate the intervention effects on patients' SSE self-efficacy. Differences between the conditions were highest when activities performed with the partner were below average (mean difference, 6.652; P = .001) and when happiness was below average (mean difference, 7.000; P = .001). Although everyone receiving the intervention experienced some benefit, the findings indicate the greatest increases in self-efficacy were observed for those with below-average activities performed with the partner and happiness.
The training of patients with melanoma and their partners in early-detection SSE benefited some more than others. Pairs who have low relationship quality, as determined by activities performed with the partner and happiness, may have received the greatest benefits from the training intervention because they were given an activity to perform together.
clinicaltrials.gov Identifier: NCT01432860.
黑色素瘤若能早期发现则生存率较高。对有患新发黑色素瘤风险的早期黑色素瘤患者进行皮肤自我检查（SSE）培训可能会提高生存率。
在由黑色素瘤患者及其皮肤检查伙伴组成的样本中，研究该干预措施对哪些人效果最佳，这些患者和伙伴接受了SSE干预或常规护理。
设计、地点和参与者：对494例0至IIB期黑色素瘤患者（平均年龄55岁；253例[51.2%]为女性）及其皮肤检查伙伴（平均年龄55岁；280例[56.7%]为女性），于2011年6月6日至2014年4月14日在门诊皮肤科办公室进行了一项随机临床试验。在12个月时进行随访评估。于2015年3月23日至6月25日进行分析。
将494例患者及其伙伴组成的二元组随机分配接受干预（395例患者）或常规护理（对照组）（99例患者）。主要结局是患者的SSE自我效能感。评估伙伴协助SSE的积极性以及关系质量（如融洽程度、与伙伴的活动以及幸福感），以判断其对干预效果影响SSE自我效能感的调节作用。
由与伙伴的活动（β = -0.892，标准误 = 0.432，t = -2.066；P = 0.001）和幸福感（β = -4.586，标准误 = 2.044，t = -2.24；P = 0.001）所定义的关系质量，显著调节了干预对患者SSE自我效能感的影响。相比之下，患者与伙伴的融洽程度（β = -0.262，标准误 = 0.148，t = -1.773；P = 0.09）和伙伴的积极性（β = -0.328，标准误 = 1.024，t = -0.320；P = 0.10）并未显著调节干预对患者SSE自我效能感的影响。当与伙伴进行的活动低于平均水平时（平均差异，6.652；P = 0.001）以及幸福感低于平均水平时（平均差异，7.000；P = 0.001），两种情况之间的差异最大。虽然接受干预的每个人都有一定益处，但研究结果表明，与伙伴进行的活动和幸福感低于平均水平的人，其自我效能感的提升幅度最大。
对黑色素瘤患者及其伙伴进行早期检测SSE培训，对一些人的益处大于其他人。根据与伙伴进行的活动和幸福感判断关系质量较低的二元组，可能从培训干预中获益最大，因为他们有一项共同进行的活动。
clinicaltrials.gov标识符：NCT01432860。
