Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression

Abstract

Background Digital strategies are innovative approaches to the prevention of skin cancer, but the attrition following this kind of intervention needs to be analyzed. Objective The aim of this paper is to assess the dropouts from studies focused on digital strategies for the prevention of skin cancer. Methods We conducted this systematic review with meta-analyses and metaregression according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statements. Search terms for skin cancer, digital strategies, and prevention were combined to search PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library from inception until July 2022. Randomized clinical trials that reported dropouts of participants and compared digital strategies with other interventions to prevent skin cancer in healthy or disease-free participants were included. Two independent reviewers extracted data for analysis. The Revised Cochrane Collaboration Bias tool was employed. We calculated the pooled dropout rate of participants through a meta-analysis of proportions and examined whether dropout was more or less frequent in digital interventions against comparators via an odds ratio (OR) meta-analysis. Data were pooled using a random-effects model. Subgroup meta-analyses were conducted in a meta-analysis of proportions and OR meta-analysis to assess the dropout events when data were sorted by digital interventions or control comparator. A univariate metaregression based on a random-effects model assessed possible moderators of dropout. Participants’ dropout rates as pooled proportions were calculated for all groups combined, and the digital and comparator groups separately. OR>1 indicated higher dropouts for digital-based interventions. Metaregressions were performed for age, sex, length of intervention, and sample size. Results A total of 17 studies were included. The overall pooled dropout rate was 9.5% (95% CI 5.0-17.5). The subgroup meta-analysis of proportions revealed a dropout rate of 11.6% for digital strategies (95% CI 6.8-19.0) and 10.0% for comparators (95% CI 5.5-17.7). A trend of higher dropout rates for digital strategies was observed in the overall (OR 1.16, 95% CI 0.98-1.36) and subgroup OR meta-analysis, but no significant differences were found between the groups. None of the covariates moderated the effect size in the univariate metaregression. Conclusions Digital strategies had a higher dropout rate compared to other prevention interventions, but the difference was not significant. Standardization is needed regarding reporting the number of and reasons for dropouts. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329669; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329669

The PROVIDE Study: Primary care assessment of the ROche IPDM tools for Validation and Implementation in Diabetes management and Evaluation

“…In a systematic review on drop out rates of digital health interventions in skin cancer, there was a median of 43% in study completion rates for observational studies. 15…”

“…In a systematic review on drop out rates of digital health interventions in skin cancer, there was a median of 43% in study completion rates for observational studies. 15 There were PwD who did not continue to record data for the 12 month service evaluation, understanding the reasons for this is an important element to further successful implementation. This may have been due to a lack of communication to PwD, regarding the benefits of the digital tool, as well as a lack of time for HCPs when implementing the onboarding process.…”

Empirical progression criteria thresholds for feasibility outcomes in HIV clinical trials: a methodological study

“…In this context, discontinuation may be related to non-usage of the electronic device precluding further meaningful participation in the trial. In skin cancer prevention research, dropout rates are higher for digital interventions than others [ 27 ].…”

Digital Health for Oncological Care

“…Such approaches have been taken in other specialties and conditions such as with stroke prevention 11 . As an additional screening example, self-monitoring for skin cancer–related lesions has been advanced via digital education tools such as Web-based interventions, smartphone apps, text messaging, and videos 12 . Similarly, telemedicine and camera-based skin image capture apps support remote lesion detection.…”

“…11 As an additional screening example, self-monitoring for skin cancer-related lesions has been advanced via digital education tools such as Web-based interventions, smartphone apps, text messaging, and videos. 12 Similarly, telemedicine and camera-based skin image capture apps support remote lesion detection. Clinical decision support and related re-minders and alerts for patients and providers, now widespread within both provider-and patient-facing parts of health systems' electronic health records, may also increase rates of recommended cancer screening.…”