Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

Abstract

PURPOSE Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior. METHODSWe conducted a pilot clustered randomized controlled trial, comparing a targeted screening and education intervention with a conventional information-based campaign in 20 private surgeries in western France. In the intervention group, 10 general practitioners identified patients at elevated risk for melanoma with a validated assessment tool, the Self-Assessment Melanoma Risk Score (SAMScore), examined their skin, and counseled them using information leaflets. In the control group, 10 general practitioners displayed a poster and the leaflets in their waiting room and examined patients' skin at their own discretion. The main outcome measures were sunbathing and skin self-examinations among patients at elevated risk, assessed 5 months later with a questionnaire.RESULTS Analyses were based on 173 patients. Compared with control patients, intervention patients were more likely to remember the campaign (81.4% vs 50.0%, P = .0001) and to correctly identify their elevated risk of melanoma (71.1% vs 42.1%, P = .001). Furthermore, intervention patients had higher levels of prevention behaviors: they were less likely to sunbathe in the summer (24.7% vs 40.8%, P = .048) and more likely to have performed skin self-examinations in the past year (52.6% vs 36.8%, P = .029). The intervention was not associated with any clear adverse effects, although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease. CONCLUSIONSThe combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.

A systematic review of interventions to improve adherence to melanoma preventive behaviors for individuals at elevated risk

“…Glanz et al, 2013; Glazebrook et al, 2006; Gritz et al, 2013; Kasparian, Meiser, Butow, Simpson, & Mann, 2009; Manne et al, 2010; Rat et al, 2014). Photoprotective methods assessed included use of protective clothing, sunscreen, and decreasing UVR exposure.…”

“…Glanz et al, 2010; Glanz et al, 2013; Glazebrook et al, 2006; Hay et al, 2006; Kasparian et al, 2009; Manne et al, 2010; Oliveria et al, 2004; Rat et al, 2014; Robinson, Turrisi, Mallett, Stapleton, & Pion, 2010; Robinson et al, 2007; Taber, Aspinwall, Leaf, Kohlmann, & Leachman, 2013). At the first assessment post-intervention, the majority of interventions targeting SSE reported significant improvements in SSE frequency (8 out of 12, 67%), but fewer targeting SSE thoroughness (1 out of 4, 25%) or both frequency and thoroughness (1 out of 3, 33%) reported improvements.…”

“…Some provided recommendations to perform SSEs in the context of delivering melanoma genetic test results (Aspinwall et al, 2008; Glanz et al, 2013), with improvements observed in SSE frequency (Aspinwall et al, 2008; Aspinwall et al, 2013; Glanz et al, 2013; Taber et al, 2013) and thoroughness (Aspinwall et al, 2008; Aspinwall et al, 2013; Taber et al, 2013). Other interventions provided more detailed instruction and tools for SSEs through in-person sessions (Berwick et al, 2000; Hay et al, 2006; Oliveria et al, 2004; Rat et al, 2014). These interventions led to significant improvements in SSE frequency but not thoroughness.…”

Why We Should Focus on Melanoma-Targeted Screening Strategies

“…Our team has developed a targeted melanoma screening procedure grounded in primary care, involving individuals at elevated risk of melanoma selected using the Self-Assessment of Melanoma risk score (SAM score) [4-11]. The procedure, based both on a validated melanoma risk assessment [4-6] and on a GP skin examination, is promising: the incidence of melanoma was multiplied by more than 10 in the selected population [7-11]. This targeted screening strategy promises to be more efficient and less burdensome than screening the general population.…”

In This Issue: Team-Based Care and Information to Improve Practice

“…5 A mixed methods study discovers practical opportunities for health behavior change for diet and physical activity. Using the Capability Framework and a community-based participatory approach, Ferrer and colleagues identify how the resources available in an economically disadvantaged community interact with personal circumstances to create capability or vulnerability.…”