Consumer Preferences for Skin Cancer Screening Using Mobile Teledermoscopy: A Qualitative Study

Abstract

Background: Mobile teledermoscopy is a rapidly advancing technology that promotes early detection and management of skin cancers. Whilst the use of teledermoscopy has proven to be effective and has a role in the detection of skin cancers, patients’ attitudes towards the multiple ways in which this technology can be utilised has not been explored. Methods: Data were obtained from a large randomised controlled trial comparing mobile teledermoscopy-enhanced skin self-examinations (SSEs) with naked-eye SSE. A semi-structured interview guide was developed by the investigators with questions focusing on people’s previous skin screening behaviours and 2 of the major pathways which can be utilised in mobile teledermoscopy: (i) direct-to-consumer and (ii) doctor-to-doctor. All interviews were tape-recorded and transcribed verbatim. Thematic analysis was undertaken by 2 independent researchers. Results: Twenty-eight participants were interviewed. Eighty-six percent of participants (n = 24/28) had previously had a clinical skin examination. Only 18% of participants (n = 5/28) visited the same doctor for each clinical skin examination. Five main themes were identified in the interviews that affected how people felt about the integration of mobile teledermoscopy into skin screening pathways: history of clinical skin examinations, continuity of the doctor-patient relationship, convenience of the direct-to-consumer teledermoscopy, expedited review enhancing the doctor-to-doctor setting and mobile teledermoscopy as a partner-assisted task. Conclusions: Overall mobile teledermoscopy was viewed positively for both direct-to-consumer and doctor-to-doctor interaction. Continuity of care in the doctor-patient relationship was not found to be a priority for clinical skin examination with most participants visiting several doctors throughout their clinical skin examination history.

A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation

“…With regard to barriers, relative to in-person care, store-and-forward teledermatology was reported to offer less clinical information to dermatologists, primary care providers, and patients (e.g., case history, available images, outcomes) [ 37 , 39 , 40 , 58 ]. Additionally, the lack of in-person contact restricted dialog between patients and dermatologists, and created communication difficulties for providing patients with diagnoses, advice, and emotional support [ 43 – 44 , 55 , 57 ].…”

“…In terms of facilitators, relative to in-person care, teledermatology consultations were more efficient and convenient and involved less travel and wait-time for patients [ 3 , 36 , 37 , 39 , 41 , 43 , 44 , 47 , 48 , 53 , 56 – 58 , 60 , 61 ]. Teledermatology also offers better access to care [ 41 , 44 , 51 , 52 , 55 ] at a lower cost [ 52 , 60 ].…”

“…Primary care providers reported a lack of confidence in implementing dermatologists’ recommendations and taking images of skin lesions [ 41 , 45 , 51 ]. Patients reported a lack of confidence in performing a self-skin exam [ 58 , 60 ]. The belief that teledermatology was not as accurate as in-person consultation was reported as a barrier in two studies [ 47 , 58 ] Facilitators in this domain were reported in 6 studies (20%).…”

“…Patients reported a lack of confidence in performing a self-skin exam [ 58 , 60 ]. The belief that teledermatology was not as accurate as in-person consultation was reported as a barrier in two studies [ 47 , 58 ] Facilitators in this domain were reported in 6 studies (20%). Teledermatology improved primary care providers’ [ 52 , 55 ] and patients’ [ 60 ] confidence in managing skin diseases.…”

“…Questionnaires (20 studies, 67% of included studies) and interviews (9 studies, 30% of included studies) were the most common methods of data collection. Only three of the thirty studies used a theoretical implementation framework to guide their investigation [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Each of the three studies used the technology acceptance model, a model designed to assess individuals' level of acceptance of technology (i.e., teledermatology).…”