Academic Primary Care Research Group, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
BMC Cancer. 2021 Nov 13;21(1):1217. doi: 10.1186/s12885-021-08959-2.
Melanoma incidence has quadrupled since 1970 and melanoma is now the second most common cancer in individuals under 50. Targeted immunotherapies for melanoma now potentially enable long-term remission even in advanced melanoma, but these melanoma survivors require ongoing surveillance, with implications for NHS resources and significant social and psychological consequences for patients. Total skin self-examination (TSSE) can detect recurrence earlier and improve clinical outcomes but is underperformed in the UK. To support survivors, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed to prompt and improve TSSE performance, with subsequent reporting of concerns and submission of skin photos to a Dermatology Nurse Practitioner (DNP). ASICA was delivered as a randomized pilot trial.
This paper reports on process evaluation. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using Microsoft Excel and SPSS. We explored which participants used ASICA, and how frequently, to report any skin concerns. We also determined how the interactions had worked in terms of quality of skin photographs submitted, clinical assessments made by the DNP, and the assessments and decisions made for each concern. Finally, we explored significant events occurring during the trial. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using SPSS. A semi-structured interview was undertaken with the DNP to gain perspective on the range of concerns presented and how they were resolved.
Of 121 recruited melanoma patients receiving ASICA for 12 months, 69 participants submitted a total of 123 reports detailing 189 separate skin-related concerns and including 188 skin photographs. Where participants fully complied with follow-up by the DNP, concerns were usually resolved remotely, but 19 (10.1%) were seen at a secondary care clinic and 14 (7.4%) referred to their GP. 49 (25.9%) of concerns were not completely resolved due to partial non-compliance with DNP follow-up.
Melanoma patients randomized to the ASICA intervention were able to report skin-related concerns that could be resolved remotely through interaction with a DNP. Feasibility issues highlighted by ASICA will support further development and optimization of this digital tool.
Clinical Trials.gov , NCT03328247 . Registered on 1 November 2017.
自 1970 年以来，黑色素瘤的发病率增加了四倍，现在是 50 岁以下人群中第二常见的癌症。针对黑色素瘤的靶向免疫疗法现在甚至可以使晚期黑色素瘤患者长期缓解，但这些黑色素瘤幸存者需要持续监测，这对国民保健制度的资源和患者的重大社会和心理后果都有影响。全面皮肤自我检查（TSSE）可以更早地发现复发并改善临床结果，但在英国的表现不佳。为了支持幸存者，开发了 Achieving Self-directed Integrated Cancer Aftercare（ASICA）干预措施，以提示和改善 TSSE 的表现，并随后向皮肤科护士从业者（DNP）报告关注问题和提交皮肤照片。ASICA 作为一项随机试点试验进行了交付。
本文报告了过程评估。使用 Microsoft Excel 和 SPSS 对参与者的人口统计学数据以及他们在试验期间报告的关注点进行了列表和显示。我们探讨了哪些参与者使用了 ASICA，以及他们报告任何皮肤问题的频率。我们还确定了交互作用在提交的皮肤照片质量、DNP 进行的临床评估以及对每个关注点的评估和决策方面的工作情况。最后，我们探讨了试验期间发生的重大事件。使用 SPSS 对参与者的人口统计学数据和他们在试验期间报告的关注点进行了列表和显示。对 DNP 进行了半结构化访谈，以了解所提出的关注问题的范围以及如何解决这些问题。
在接受 ASICA 治疗 12 个月的 121 名黑色素瘤患者中，有 69 名参与者共提交了 123 份报告，详细说明了 189 个单独的皮肤相关问题，并包括 188 张皮肤照片。在完全遵守 DNP 随访的情况下，参与者的问题通常可以远程解决，但有 19 名（10.1%）在二级保健诊所就诊，14 名（7.4%）转介给他们的全科医生。由于对 DNP 随访的部分不遵守，49 名（25.9%）的问题没有完全解决。
随机分配到 ASICA 干预组的黑色素瘤患者能够报告皮肤相关问题，这些问题可以通过与 DNP 互动来远程解决。ASICA 提出的可行性问题将支持该数字工具的进一步开发和优化。
ClinicalTrials.gov，NCT03328247。于 2017 年 11 月 1 日注册。
