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.
BMC Cancer. 2020 Feb 14;20(1):123. doi: 10.1186/s12885-019-6476-5.
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.
This is an observational study with longitudinal assessments conducted with adult melanoma patients in active follow-up care.
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.
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.
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.
如果黑色素瘤不能早期发现和治疗，就会致命。通过皮肤自我检查（SSE）可以促进早期发现，因此，SSE 是既往有黑色素瘤病史者的随访护理的一部分，他们终生面临复发的风险。本研究的目的是确定黑色素瘤幸存者 SSE 的短期和长期预测因素，以便为高危人群提供未来的预防干预措施。
这是一项对正在接受主动随访护理的成年黑色素瘤患者进行的观察性研究，进行了纵向评估。
在皮肤癌预防的皮肤科教育课程后 3、12 和 24 个月，评估行为结果、全面 SSE（在过去 3 个月内检查多达 5 个身体部位）和最佳 SSE（在过去 3 个月内至少每月检查整个身体）。使用 t 检验和卡方检验分析从 3 个月到 12 个月和 24 个月的结果变化。线性和逻辑回归模型用于检验预测因素与主要结果之间的关系。
从教育课程后 3（M=2.7，SD=1.1）到 12（M=2.6，SD=1.2）和 24 个月（M=2.4，SD=1.2），全面 SSE 并没有显著下降，所有时间点的最强预测因素都是进行 SSE 的意愿。在教育课程后 3 个月（59%）时，最佳 SSE 高于 12 个月（46%）和 24 个月（34%），3 个月时的主要预测因素包括自我效能感和进行 SSE 的意愿以及男性性别；12 个月时包括自我效能感和对医疗建议的依赖；24 个月时包括（较低的）教育程度和自我效能感。
本研究的主要发现是，1）幸存者随着时间的推移保持 SSE 行为，但与医疗建议一致的 SSE 率在标准皮肤科教育（即常规护理）后立即更高，并在 24 个月的时间内有所下降；2）SSE 的最强心理社会预测因素是进行行为的意愿和自我效能感，这些因素是高度可改变的，例如通过动机性访谈和目标设定健康干预。
