Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care

Abstract

BackgroundMelanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology.Methods/DesignThe longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings.DiscussionThe identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.

Predictors of skin self-examination before and after a melanoma diagnosis: the role of medical advice and patient’s level of education

“…However, these findings speak to 1) clinicians’ adherence to care guidelines, and 2) patients’ willingness for behavioral change. Further, the current study suggests that future intervention programs seeking to enhance SSE practice may be more effective if socio-demographic characteristics (e.g., educational status) of the target population are taken into account [14,15]. …”

Mitogen-Activated Protein Kinase Signal Transduction in Solid Tumors

“…Over-exposure to ultraviolet radiation and sunbed exposure may add the risk (Curiel-Lewandrowski et al, 2012), which can be more susceptible in younger people (Cust et al, 2011). Usually, melanoma is recognizable and highly curable when detected early, some studies show that timely skin self-examination may be of great help (Curiel-Lewandrowski et al, 2012;Korner et al, 2013). Reducing rates of sun-burnt, Early Detection, Melanoma is recently considered to be a heterogeneous group of cancers with distinct mutational profiles (Rebecca et al, 2012).…”

Effects of web-based intervention on risk reduction behaviors in melanoma survivors

“…For example, only half (51 %) of a general US population of melanoma survivors perform thorough skin self-examinations [13]. Some of these studies employed clinic-based samples, which could selectively recruit more adherent individuals, those more worried about recurrence or those with better insurance coverage and SES than the general population.…”