The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.
Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
Int J Cancer. 2024 Dec 1;155(11):2058-2067. doi: 10.1002/ijc.35146. Epub 2024 Aug 23.
Population-wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk-based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk-tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk-tailored skin check schedule. Data were collected from the risk tool, clinician-recorded data on schedule deviations, and appointment booking system. Post-consultation, we conducted semi-structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk-tailored skin check schedules. In cases of non-adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non-adherence among patients included anxiety and wanting autonomy around decision-making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk-tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk-based recommendations with patients.
目前，大多数国家并不推荐进行全民皮肤癌筛查。相反，大多数临床指南都包含基于风险的皮肤检查建议，尽管在实践中，有关实施和遵循建议的证据有限。我们旨在确定对个人风险定制的黑色素瘤皮肤检查时间表的遵守情况，并探讨影响遵守情况的原因。邀请在澳大利亚悉尼的澳大利亚黑素瘤研究所的三级皮肤科诊所就诊的患者（有/无先前的黑色素瘤）通过 iPad 完成黑色素瘤风险评估问卷，并提供个人风险信息以及风险定制的皮肤检查时间表。数据是从风险工具，临床医生记录的时间表偏差数据以及预约系统中收集的。在咨询后，我们对患者和诊所工作人员进行了半结构化访谈。我们使用集中隔离混合方法分析进行分析。访谈进行了录音，转录并进行了主题分析。参与者数据是从诊所记录（n=247）和访谈（n=29 名患者，11 名工作人员）中分析得出的。总体而言，对风险定制的皮肤检查时间表的遵守率为 62％。在不遵守的情况下，皮肤检查往往比建议的更频繁。偏离决定同样受到患者（44％）和临床医生（56％）的影响。导致患者不遵守的主题包括焦虑和对决策自主权的渴望，而导致临床医生不遵守的主题包括对特定病变和风险估计准确性的担忧。对个人风险定制皮肤检查建议的临床服务计划的遵守率适中。通过采用识别和帮助焦虑水平较高的患者并支持临床医生与患者沟通基于风险的建议的策略，可能会进一步提高遵守率。
