Drabarek Dorothy, Habgood Emily, Janda Monika, Hersch Jolyn, Ackermann Deonna, Low Don, Low Cynthia, Morton Rachael L, Dieng Mbathio, Cust Anne E, Morgan Adelaide, Smith Elloise, Bell Katy L J
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
JMIR Dermatol. 2022 Jul 1;5(3):e35916. doi: 10.2196/35916.
Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation.
This study aims to explore patients' experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care.
Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model.
We interviewed 20 patients (n=8, 40% women and n=12, 60% men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness.
Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.
当前由临床医生主导的黑色素瘤监测模式要求患者定期频繁就诊，这给患者带来了出行、费用和时间负担。患者主导的监测是一种新的后续护理模式，它可以减少诸如门诊就诊和医疗程序等医疗保健的使用及其相关成本，增加获得护理的机会，并促进原发性黑色素瘤治疗后后续新发黑色素瘤的早期诊断。了解患者的体验可能有助于改进实施情况。
本研究旨在探讨患者在参与MEL-SELF试点随机对照试验的6个月期间对患者主导监测的体验和看法。除常规护理外，患者主导的监测包括定期皮肤自我检查、使用移动皮肤镜对可疑病变进行成像，以及使用智能手机应用程序跟踪并将图像发送给远程皮肤科医生进行评估。
对澳大利亚新南威尔士州先前接受过皮肤局限性黑色素瘤治疗、并在试验中被随机分配到患者主导监测组（干预组）的患者进行了半结构化访谈。采用主题分析法，参照技术接受模型对数据进行分析。
我们采访了20名患者（8名女性，占40%；12名男性，占60%；中位年龄62岁）。依从性较高的患者体验到了一些益处，如对自身皮肤的关注度提高、皮肤自我检查习惯改善、黑色素瘤的早期发现，以及积极管理临床随访的机会。大多数参与者在获取清晰图像和应用程序的技术问题上遇到困难。有数字技术使用经验的参与者以及在皮肤检查伙伴（如配偶、兄弟姐妹或朋友）的有效帮助下克服或坚持克服了这些障碍。痣太多或太少会降低感知有用性。
黑色素瘤患者接受并从使用远程皮肤镜的患者主导监测中获益。增加对患者及其皮肤检查伙伴的培训和技术支持，可能有助于实现这种新的黑色素瘤监测模式的全部潜在益处。
