描述、预测和解释黑素瘤患者进行全身皮肤自我检查（TSSE）的依从性：一项为期 12 个月的纵向研究。

Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma: a 12-month longitudinal study.

机构信息

Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

Aberdeen Health Psychology Group, School of Psychology, University of Aberdeen, Aberdeen, UK.

出版信息

BMJ Open. 2022 Aug 30;12(8):e056755. doi: 10.1136/bmjopen-2021-056755.

DOI:10.1136/bmjopen-2021-056755

PMID:36041758

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9438032/

Abstract

OBJECTIVES

To describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline.

DESIGN

A longitudinal observational study nested within the intervention arm of the ASICA (Achieving Self-Directed Integrated Cancer Aftercare) randomised controlled trial.

SETTING

Follow-up secondary care in Aberdeen and Cambridge UK.

PARTICIPANTS

n=104 adults (48 men/56 women; mean age 58.83 years, SD 13.47, range 28-85 years; mean Scottish Index of Multiple Deprivation score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial.

INTERVENTIONS

All participants were using the ASICA intervention-a tablet-based intervention designed to support monthly TSSE.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app.

RESULTS

Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent.

CONCLUSIONS

Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03328247).

摘要

目的

描述黑色素瘤幸存者在 12 个月内每月进行全身皮肤自我检查（TSSE）的依从轨迹，并探讨在基线时，依从轨迹是否可以从人口统计学、认知或情绪因素预测。

设计

嵌套在 ASICA（实现自我导向的综合癌症康复）随机对照试验干预臂中的纵向观察研究。

地点

英国阿伯丁和剑桥的二级保健。

参与者

n=104 名成年人（48 名男性/56 名女性；平均年龄 58.83 岁，标准差 13.47，范围 28-85 岁；平均苏格兰多维贫困指数得分 8.03，标准差 1.73，范围 2-10），他们在过去 60 个月内接受了 0-IIC 期原发性皮肤黑色素瘤的治疗，并且正在积极参与 ASICA 试验的干预臂。

干预措施

所有参与者均使用 ASICA 干预措施-一种旨在支持每月 TSSE 的基于平板电脑的干预措施。

主要和次要结果测量

主要结果是在 12 个月内遵循指南推荐的（每月）TSSE。这是通过 ASICA 干预应用程序记录的时间标记的 TSSE 数据确定的。

结果

潜在增长混合模型确定了三种 TSSE 依从轨迹（依从者-41%；下降者-35%；不依从者-24%）。不依从者不太可能按照建议进行 TSSE，他们打算更频繁地进行 TSSE（OR=0.21，95%CI 0.06 至 0.81，p=0.023），而且抑郁程度更高（OR=1.31，95%CI 1.06 至 1.61，p=0.011），依从者。随着时间的推移，依从性下降的人行动计划发展得较差（OR=0.78，95%CI 0.63 至 0.96，p=0.016），对 TSSE 的自我效能感较低（OR=0.92，95%CI 0.86 至 0.99，p=0.028），而依从者。