Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

Abstract

SummaryBackgroundThe increasing incidence of actinic keratosis (AK) is causing a large burden on healthcare systems. The current management of patients with AK seems to vary within and between primary and secondary care; however, an in‐depth understanding of healthcare providers’ management of AK is currently lacking.ObjectivesTo gain insight into the management of AK by exploring the underlying motives of current practices among general practitioners (GPs) and dermatologists in the Netherlands.MethodsA qualitative study was conducted consisting of semistructured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim and inductively analysed by two researchers drawing on elements of grounded theory.ResultsGPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK. They mainly applied cryotherapy or referred to secondary care due to lack of experience, varying in their applications and providing mostly patient‐driven follow‐up care. They also reported a great need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated pursuing proactive clinical assessments of cutaneous photodamage and the goal of providing guideline‐driven AK care. However, patient preferences still largely influence both treatment choices and follow‐up regimens. Furthermore, dermatologists reported the need to improve AK and skin cancer management in primary care.ConclusionsFor AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

“…Nowadays, choosing an appropriate and individualized intervention often largely depends on the knowledge, expertise, and preference of the practitioner as well as reimbursement status and may be insufficiently aligned with the individual desire of the patient [22,23]. In a recent qualitative study among physicians, cryosurgery was cited as the predominant therapy because other forms of therapy were little known or because there was uncertainty about their use [24]. Nevertheless, most dermatologists in this qualitative survey stated that they were aiming for guideline-based therapy, which was also an important motivation for patients in our study.…”

Accuracy of a smartphone application for triage of skin lesions based on machine learning algorithms

“…For a user checking the skin lesions with this SA, it may prove difficult to evaluate all relevant skin lesions, as lay users may not know which lesions could be dangerous and/or which the user cannot see (namely for users taking an image without a partner and/or if the lesions are located in places which are hard to reach). On the other hand, this may also occur in current clinical practice as previous studies suggested GPs usually do not perform a full‐body skin examination …”

“…On the other hand, this may also occur in current clinical practice as previous studies suggested GPs usually do not perform a full-body skin examination. 20,21 These risks are mitigated by the SA in several ways. First, every pair of image and corresponding risk rating gets a quality control by a dermatologist.…”

Virtual consultation for actinic keratosis

“… 3 A Dutch qualitative study highlighted that some primary care clinicians’ principal approach to managing AK was treatment with cryosurgery, or referral to secondary care with patient-driven follow-up care. 4 This article aims to inform GPs on the management of AK based on the British Association of Dermatologists (BAD) guidelines, the authors’ opinions on effective virtual consultations on AK, and when to refer patients to secondary care.…”