Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care
1 Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
2 Lady Davis Institute for Medical Research, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
3 Louise-Granofsky-Psychosocial Oncology Program, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
4 Melanoma Clinic, Royal Victoria Hospital, MGill University Health Centre, 687 Pine Avenue West, Montréal, QC, H3A 1A1, Canada
5 Department of Dermatology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
6 Department of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
7 Segal Cancer Centre, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
BMC Dermatology 2013, 13:3 doi:10.1186/1471-5945-13-3Published: 1 March 2013
Melanoma 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.
The 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.
The 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.