Effects of Tailored Risk Communications for Skin Cancer Prevention and Detection: The PennSCAPE Randomized Trial

Abstract

Background Prevention and early detection measures for melanoma, such as sun avoidance and skin examinations, are important, but are practiced inconsistently. In this replication of the Project SCAPE trial, we sought to determine whether tailored print materials were more effective at improving adherence than generic print materials for patients at increased-risk of skin cancer. Methods Participants were randomized to receive personalized mailed communications about their skin cancer risk and recommended sun protection, or generic mailings. Participants were Caucasian adults, at moderate or high risk for skin cancer, recruited in outpatient primary care. The main outcomes were overall sun protection behaviors and specific protective behaviors including use of sunscreen, shirt, hat, sunglasses, shade and sun avoidance; recent sunburns; and skin self-examination and provider skin examination. Results One hundred ninety-two (93.2%) subjects completed the study. Six outcome variables showed significant intervention condition effects in mixed effects models: overall sun protection behavior (p = .025); sunscreen use (p = .026); use of sunglasses (p = .011); sunburns in the past three months (p = .033); recency of last skin self-exam (p = .017); and frequency of skin exams by health care provider (p = .016). Conclusions Relative to generic communications, tailored risk communications resulted in improved adherence to six skin cancer protective behaviors, including a composite sun protection behavior measure, sunburns, and health care provider skin examinations. Impact Tailored interventions can be more effective in improving patient prevention behaviors than non-tailored, generic information for patients at moderate to high risk of skin cancer.

Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019

“…Four studies assessed sun‐related attitudes, of which three found significant differences in the sun risk attitude and perceived sun damage susceptibility . Sixteen studies found a significant protective behavioural changes and two studies reported significant changes in the intention to change sun protection behaviour …”

Self-reported sunscreen use and urinary benzophenone-3 concentrations in the United States: NHANES 2003–2006 and 2009–2012

“…Self-reported sunscreen use is also used as one way of evaluating the efficacy of public health campaigns aimed at increasing sun avoidance behaviors and preventing skin cancer (Buller et al 2015; Glanz et al 2015; Youl et al 2015). It is therefore important to understand the validity of self-reported frequency of sunscreen use.…”

Real-time sun protection decisions in first-degree relatives of melanoma patients.

“…Yet the predominant self-report assessments for sun protection (Centers for Disease Control and Prevention, 2007) are not designed to assess consistency of sun protection, as they direct respondents to generate a cumulative frequency over a broad time period (e.g., “sometimes” or “most of the time” using sunscreen while outside on a sunny day last summer). Using these global self-report methods, it appears that individuals with a family history of melanoma use sun protection inconsistently (Azzarello, Dessureault, & Jacobsen, 2006; Bishop et al, 2007; Geller et al, 2006), and even well-designed, personalized interventions do not resolve this inconsistency (Azzarello et al, 2006; Glanz et al, 2015; Manne et al, 2010). For example, Glanz and colleagues (Glanz et al, 2015) examined the influence of tailored risk information on sun protection among individuals at risk of melanoma and found that while sunscreen use increased significantly in the intervention group, that substantial inconsistency remained.…”

“…Using these global self-report methods, it appears that individuals with a family history of melanoma use sun protection inconsistently (Azzarello, Dessureault, & Jacobsen, 2006; Bishop et al, 2007; Geller et al, 2006), and even well-designed, personalized interventions do not resolve this inconsistency (Azzarello et al, 2006; Glanz et al, 2015; Manne et al, 2010). For example, Glanz and colleagues (Glanz et al, 2015) examined the influence of tailored risk information on sun protection among individuals at risk of melanoma and found that while sunscreen use increased significantly in the intervention group, that substantial inconsistency remained. Understanding the decisions that lead to sun protection use is critical to the development of interventions to address pervasive inconsistency in these behaviors.…”