GPs’ involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study

Abstract

Background: In Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP.Aim: To identify factors influencing GPs' decisions to diagnose, treat, or refer patients with suspected melanoma.Design & setting: Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. Method:The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data.Results: Considerable variation existed in GPs' self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs' decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP's clinical interests, Smith AL et al.the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management.Conclusion: GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate. How this fits inIn Australia, melanoma can potentially be diagnosed and treated wholly within the primary care setting, yet little is known about how GPs decide how involved they wish to be in melanoma management. This qualitative interview study reveals the diversity of GP engagement in melanoma management and highlights how GPs' involvement can extend well beyond prevention, early detection, and supportive care to include provision of definitive melanoma management. The study identifies multiple factors influencing a GP's decision to treat or refer a patient with melanoma. The findings indicate that more attention should be given to GPs' involvement in melanoma management, in particular to how GPs can be further supported to deliver optimal melanoma care.

The effect of screening on melanoma incidence and biopsy rates

“…To date, Germany is the only country in which a population‐based programme has been introduced for the early detection of melanoma and other skin cancers, although it remains an open question whether or not the programme has delivered mortality benefits 4 . While there is no systematic programme for the early detection of melanoma in Australia, whole‐body skin examinations are commonly offered by primary care physicians, 5 and there are many medical practitioners whose sole clinical activity is ‘skin cancer detection and treatment’ 6 . As such, a sizeable proportion of the Australian population undergoes regular screening for melanoma and skin cancer each year 7 …”

Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

“…Furthermore, including GPs who work full time in skin cancer screening clinics would have been valuable. This is particularly relevant in Australia where, unlike other countries, it is not uncommon for melanomas to be managed entirely within the primary care setting ( Smith et al, 2020 ).…”

Too much theory and not enough practice? The challenge of implementation science application in healthcare practice

“…program has encouraged IS ideas to be more impactful with wide stakeholder groups, when presented through simple, jargon free communication, 71 and has helped inform policy, clinical guidelines and improvement goals. 72 By encouraging healthcare professionals to attend IS meetings and specialist workshops, a growing learning community is taking shape. Implementation scientists engage with the overall program functioning, and learning collaboratives reflect well on the work of the whole CRE.…”

“…By underpinning the research of the CRE in Melanoma with implementation models, while integrating melanoma clinicians and researchers into IS methodologies (alongside economic evaluation and policy assessment), implementation scientists and healthcare practitioners are gaining a mutual understanding of roles, the work context and intervention practice outcomes. Integration early in this program has encouraged IS ideas to be more impactful with wide stakeholder groups, when presented through simple, jargon free communication, 71 and has helped inform policy, clinical guidelines and improvement goals 72 . By encouraging healthcare professionals to attend IS meetings and specialist workshops, a growing learning community is taking shape.…”