Adherence to melanoma screening and surveillance skin check schedules tailored to personal risk

Abstract

AbstractPopulation‐wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk‐based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk‐tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk‐tailored skin check schedule. Data were collected from the risk tool, clinician‐recorded data on schedule deviations, and appointment booking system. Post‐consultation, we conducted semi‐structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk‐tailored skin check schedules. In cases of non‐adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non‐adherence among patients included anxiety and wanting autonomy around decision‐making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk‐tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk‐based recommendations with patients.