Australian general practitioners’ attitudes and knowledge of sentinel lymph node biopsy in melanoma management

Watts, Caroline; Smith, Andrea L.; Robinson, Sam; Chang, Chiao Han; Goumas, Chris; Schmid, Helen; Kelly, John W.; Hong, Angela; Scolyer, Richard A.; Long, Georgina V.; Spillane, Andrew J.; Henderson, Michael A.; Gyorki, David E.; Mar, Victoria; Morton, Rachael L.; Saw, Robyn P.M.; Varey, Alexander H. R.; Mann, Graham J.; Thompson, John F.; Cust, Anne E.

doi:10.31128/ajgp-10-19-5138

Cited by 4 publications

(8 citation statements)

References 21 publications

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“…A study in Queensland reported that general practitioners and those in primary care with an interest in skin cancer diagnosed up to 80% of melanoma 10 . A 2020 New South Wales study reported that although 68% of general practitioners surveyed thought SNB played an important role in the management of melanoma, only 32% described themselves as being familiar with the guidelines for the indication for a SNB 16 . In that survey, those who discussed SNB with eligible patients, less than 40% correctly identified that SNB was recommended for patients with melanoma >1 mm thick 16 .…”

Section: Discussionmentioning

confidence: 99%

Trends and patterns of care of sentinel node biopsy in cutaneous melanoma: a population‐based study in Queensland

Wong

Moore

Soyer

et al. 2023

ANZ Journal of Surgery

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BackgroundSentinel node biopsy (SNB) has evolved from offering staging and prognostication to a procedure that guides therapeutic management. The aim was to evaluate the rate of SNB for patients with high‐risk melanoma and assess factors that may have impacted on the procedure being performed.MethodsData of patients with primary invasive cutaneous melanoma from 01 January 2009 to 31 December 2019 were obtained from the Queensland Oncology Repository. High‐risk melanoma was defined as ≥0.8 mm thick or < 0.8 mm with ulceration present (AJCC eighth edition pT1b–pT4).Results14 006 (33.8%) of 41 412 patients diagnosed with cutaneous invasive melanoma were in the high‐risk group. 2923(20.9%) patients had SNB, with the rate increasing from 14.2% (2009) to 36.8% (2019) (P = 0.002), and an increasing proportion being performed in public hospitals over the 11 year period (P = 0.02). Older age (OR0.96 (0.959–0.964) (P < 0.001)), female (OR0.91 (0.830–0.998) (P = 0.03)), head and neck primary (OR0.38 (0.33–0.45) (P < 0.001)), and pT1b (OR0.22 (0.19–0.25) (P < 0.001)) were factors associated with SNB not being performed. Travel out of the Hospital and Health Services of residence for SNB occurred in 26.2%. Although the travel rate decreased from 24.7% (2009) to 23.0% (2019) (P = 0.04), the absolute number increased due to the increase in SNB rate. Those most likely to travel were younger, from remote areas, or from affluent backgrounds.ConclusionIn this first Australian population‐based study, there was an increased adherence to SNB guideline, although overall SLNB rates remain low, with nearly 2/3 of eligible cases not having the procedure in 2019. Although travel rates decreased marginally, the overall number increased. This study highlights the crucial need to further improve access to SNB for melanoma surgery for the Queensland population.

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Section: Discussionmentioning

confidence: 99%

Trends and patterns of care of sentinel node biopsy in cutaneous melanoma: a population‐based study in Queensland

Wong

Moore

Soyer

et al. 2023

ANZ Journal of Surgery

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“…[22][23][24][25] High levels of variability in diagnostic accuracy have been found between individual GPs, 26,27 and high variability in GPs familiarity with best practice guidance on high-risk excisions 28 and use of sentinel lymph node biopsy. 29 Skin cancer focused protocols and guidelines have been developed by dermatological and oncological societies (e.g. for surgical excision 30 ), but these have rarely detailed the role to be played by primary care.…”

Section: Introductionmentioning

confidence: 99%

“…Research has drawn attention to GPs' capabilities in managing skin cancer but also to concerns around variation in the quality of care 22–25 . High levels of variability in diagnostic accuracy have been found between individual GPs, 26,27 and high variability in GPs familiarity with best practice guidance on high‐risk excisions 28 and use of sentinel lymph node biopsy 29 …”

Section: Introductionmentioning

confidence: 99%

Measuring the quality of skin cancer management in primary care: A scoping review

et al. 2023

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Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.

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“…Given that appropriate treatment and management is increasingly dependent on accurate staging, it is important to understand why rates might be low. Our previous research in Australia has shown that although there is ‘in principle’ support of the role of SN biopsy in accurately staging patients with melanoma, some dermatologists express disagreement with and distrust of the guideline recommendations for SN biopsy [ 14 ], and primary care physicians commonly have low levels of understanding of the recommendations [ 15 ]. These knowledge gaps and distrust of the recommendations are potentially concerning as primary care physicians and dermatologists are typically the first point of contact for people diagnosed with melanoma [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing acceptance, adoption and adherence to sentinel node biopsy recommendations in the Australian Melanoma Management Guidelines: a qualitative study using an implementation science framework

Smith

Watts

Henderson

et al. 2022

Implement Sci Commun

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Background Sentinel node biopsy (SN biopsy) is a surgical procedure used to accurately stage patients with primary melanoma at high risk of recurrence. Although Australian Melanoma Management Guidelines recommend SN biopsy be considered in patients with melanomas > 1 mm thick, SN biopsy rates in Australia are reportedly low. Our objective was to identify factors impacting the acceptance, adoption and adherence to the Australian SN biopsy guideline recommendations. Methods Opinions of Australian key informants including clinicians, representatives from melanoma education and training providers, professional associations and colleges, and melanoma advocacy organisations were collected through semi-structured interviews (n = 29) and from publicly released statements (n = 14 news articles). Data analysis involved inductive and deductive thematic analysis using Flottorp’s determinants framework. Results A complex interplay of contemporary and historical factors was identified as influencing acceptance, adoption and adherence to the SN biopsy guideline recommendations at the individual, guideline, patient, organisational and social levels. Expert and peer opinion leaders have played an important role in facilitating or inhibiting adoption of guideline recommendations, as have financial incentives driven by healthcare-funding policies and non-financial incentives including professional identity and standing. Of critical importance have been the social and knowledge boundaries that exist between different professional groups to whom the guidelines apply (surgeons, dermatologists and primary care practitioners) with adherence to the guideline recommendations having the potential to shift work across professional boundaries, altering a clinician’s workflow and revenue. More recently, the emergence of effective immunotherapies and targeted therapies for patients at high risk of recurrence, the emergence of new opinion leaders on the topic (in medical oncology), and patient demands for accurate staging are playing crucial roles in overcoming the resistance to change created by these social and knowledge boundaries. Conclusions Acceptance and adherence to SN biopsy guideline recommendations in Australia over the past 20 years has involved a process of renegotiation and reframing of the evidence for SN biopsy in melanoma by clinicians from different professional groups and networks. This process has helped to refine the evidence for SN biopsy and our understanding of appropriate adoption. New effective systemic therapies have changed the balance towards accepting guideline recommendations.

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Australian general practitioners’ attitudes and knowledge of sentinel lymph node biopsy in melanoma management

Cited by 4 publications

References 21 publications

Trends and patterns of care of sentinel node biopsy in cutaneous melanoma: a population‐based study in Queensland

Trends and patterns of care of sentinel node biopsy in cutaneous melanoma: a population‐based study in Queensland

Measuring the quality of skin cancer management in primary care: A scoping review

Factors influencing acceptance, adoption and adherence to sentinel node biopsy recommendations in the Australian Melanoma Management Guidelines: a qualitative study using an implementation science framework

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