Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score

Jackson, Arthur; Wilkinson, Clare; Ranger, Margaret; Pill, Roisin; August, P.J.

doi:10.1136/bmj.316.7124.34

Cited by 43 publications

(43 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[3][4][5][6] Such a strategy depends on individuals recognising that they are at higher risk and being willing to come forward for screening. However, British surveys based on both aZuent 5 and demographically more representative 7 populations suggest that individuals are rather poor at assessing their own risk status and may be especially reluctant to assign themselves to a high risk category.…”

mentioning

confidence: 99%

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

et al. 2000

View full text Add to dashboard Cite

Objectives-To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. Design-A population based cross sectional survey. Setting-A general practice with a broad mix of socioeconomic groups in one district health authority. Subjects-A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. Main outcome measures-Questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. Results-Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more aZuent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. Conclusions-Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral. (J Med Screen 2000;7:199-202)

show abstract

mentioning

confidence: 99%

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Using the four cut-off points of the Williams model in this study would identify between 4% and 20% of the population as candidates for a targeted intervention, and those groups would contain between approximately 30% and 60% respectively, of those likely to develop melanoma. This is not dissimilar to the 8Á7% of the population identified as 'worryingly high risk' or 'very increased risk' in the study by Jackson et al 25 While such strategies are likely to increase local referral rates and dermatology workload, and there is a U.K. shortage of dermatologists, a recent review suggests that melanoma early detection programmes might be cost-effective 14 if targeted at high-risk populations such as older men 32 or those with a family history of melanoma. 12 It is likely that identifying higher-risk individuals using a risk score would be more cost-effective, but further studies are needed to confirm this and to determine the most cost-effective intervals for surveillance amongst those at different levels of risk.…”

Section: Discussionmentioning

confidence: 71%

“…However, the same biases would be true for the original Williams model, which performed well in an external validation cohort and in this study we additionally included photographs of moles and freckles to help participants distinguish between them, which, if anything, would be expected to improve the performance of the model. Only one similar study has been conducted for melanoma risk, 25 where patients at 16 English general practices completed a paper questionnaire based on a risk score developed by Mackie. 26 While this is, therefore, the first study to use tablet computers to collect melanoma or any other cancer-specific risk factor information in general practice waiting rooms, tablet computers have been used in this setting previously.…”

Section: Discussionmentioning

confidence: 99%

Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey

et al. 2016

View full text Add to dashboard Cite

SummaryBackground Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches. Objectives To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care. Methods We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model. Results Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17Á15 AE 8Á51, with small regional differences [lower in England compared with Scotland (P = 0Á001) and Wales (P < 0Á001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma. Conclusions Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.

show abstract

“…Melanoma can affect people of both sexes, and affects young people disproportionately. 10 Most people with melanoma survive for prolonged periods but recurrence is common, so long-term follow-up is recommended. 11 Detected early, recurrent melanoma can be treated by surgery, which improves survival.…”

Section: Resultsmentioning

confidence: 99%

Designing an integrated follow-up programme for people treated for cutaneous malignant melanoma: a practical application of the MRC framework for the design and evaluation of complex interventions to improve health

et al. 2007

View full text Add to dashboard Cite

a Murchie P, Hannaford PC, Wyke S, Nicolson MC and Campbell NC. Designing an integrated follow-up programme for people treated for cutaneous malignant melanoma: a practical application of the MRC framework for the design and evaluation of complex interventions to improve health. Family Practice 2007; 24: 283-292. Background. Complex health care interventions are difficult to design and evaluate, so the UK Medical Research Council (MRC) has developed a 'framework for the design and evaluation of complex health care intervention'. Researchers differ in applying the framework. Objective. To describe and critically evaluate how the two initial phases of the MRC framework facilitate the design of an integrated follow-up programme for cutaneous melanoma to a standard suitable for testing in an exploratory randomized trial.Design of study. Literature review, expert groups, semi-structured interviews and pilot exercise to develop an intervention. Setting. A department of academic primary care. Two general practices.Methods. Four techniques were used-iterative literature review, a steering group, semistructured telephone interviews and an operationalization exercise. These techniques were used simultaneously and iteratively to complete the theoretical preclinical and phase I modelling of the MRC framework when developing an integrated follow-up programme for cutaneous melanoma.Results. Components of an integrated follow-up programme for cutaneous malignant melanoma were identified, developed and refined into a practical intervention comprising GP training; structured protocol-driven appointments; a centralized recall system; a rapid access pathway and a patient information booklet. Several barriers that could have derailed the successful implementation of the intervention, including the different perspectives of stakeholders and resource needs in general practice were identified. The value of the principles of the initial two phases of the MRC framework in guiding the development of complex health care interventions was supported.Conclusions. We recommend that the first two phases of the MRC framework be used iteratively and simultaneously when developing complex health care interventions.

show abstract

Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score

Cited by 43 publications

References 22 publications

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey

Designing an integrated follow-up programme for people treated for cutaneous malignant melanoma: a practical application of the MRC framework for the design and evaluation of complex interventions to improve health

Contact Info

Product

Resources

About