title: Patient adherence to skin self-examination. effect of nurse intervention with photographs.
abstract: BACKGROUND
  Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation.
  
  
  METHODS
  Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?"
  
  
  RESULTS
  In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001).
  
  
  CONCLUSIONS
  The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.
authors.affiliation: Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA. oliveri1@mskcc.org
authors.forename: Susan A
authors.initials: SA
authors.lastname: Oliveria
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dusza
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Phelan
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Ostroff
authors.forename: Marianne
authors.initials: M
authors.lastname: Berwick
authors.forename: Allan C
authors.initials: AC
authors.lastname: Halpern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004416:Dysplastic Nevus Syndrome / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000517:prevention & control; D008875:Middle Aged; D009519:New York City; D010174:Pamphlets; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D010781:Photography; D012648:Self Care / Q000706:statistics & numerical data; D016353:Self-Examination / Q000451:nursing*; D017592:Skin Care / Q000451:nursing*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D011795:Surveys and Questionnaires