title: Patients at elevated risk of melanoma: individual predictors of non-compliance to GP referral for a dermatologist consultation.
abstract: OBJECTIVE
  The aim of this study is to assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a General Practitioner referral and to determine individual predictors of non-compliance.
  
  
  METHODS
  This survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011. Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment). Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression.
  
  
  RESULTS
  Compliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR=13.22; [7.66-23.56]); no previous participation in cancer screenings, including smear tests (OR=5.03; [2.23-11.83]) and prostate screening (OR=2.04; [1.06-3.97]); lack of knowledge that melanoma was a type of cancer (OR=1.94; [1.29-2.92]); and reporting no time to make an appointment (OR=2.08; [1.82-2.38]), forgetting to make an appointment (OR=1.26; [1.08-1.46]), long delays in accessing an appointment (OR=1.25; [1.12-1.41]), not being afraid of detecting something abnormal (OR=1.54; [1.35-1.78]), no need to consult a dermatologist to feel secure (OR=1.28; [1.09-1.51]).
  
  
  CONCLUSIONS
  Physicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better General Practitioner counseling might enhance compliance in high-risk populations.
authors.affiliation: Department of General Practice, Faculty of Medicine, Nantes, France; Onco-dermatology Department, Nantes University Hospital, France. Electronic address: cedric.rat@univ-nantes.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.affiliation: Onco-dermatology Department, Nantes University Hospital, France; French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299)-team 2, France. Electronic address: gaelle.quereux@chu-nantes.fr.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Quereux
authors.affiliation: Department of General Practice, Faculty of Medicine, Nantes, France. Electronic address: marinedusorbier@wanadoo.fr.
authors.forename: Marine
authors.initials: M
authors.lastname: Monegier du Sorbier
authors.affiliation: Department of Epidemiology and Biostatistics, Nantes University Hospital, France. Electronic address: aurelie.gaultier@chu-nantes.fr.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gaultier
authors.affiliation: Department of Social Studies, Faculty of Medicine, Nantes, France. Electronic address: angelique.bonnaud@univ-nantes.fr.
authors.forename: Angélique
authors.initials: A
authors.lastname: Bonnaud-Antignac
authors.affiliation: Onco-dermatology Department, Nantes University Hospital, France; French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299)-team 2, France. Electronic address: akhammari@chu-nantes.fr.
authors.forename: Amir
authors.initials: A
authors.lastname: Khammari
authors.affiliation: Onco-dermatology Department, Nantes University Hospital, France; French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299)-team 2, France. Electronic address: brigitte.dreno@wanadoo.fr.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.affiliation: Department of Epidemiology and Biostatistics, Nantes University Hospital, France; French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299)-team 2, France. Electronic address: jean-michel.nguyen@univ-nantes.fr.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D003376:Counseling; D003880:Dermatology / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005602:France; D058005:General Practitioners / Q000592:standards / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000517:prevention & control*; D008875:Middle Aged; D009790:Occupations; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors
keywords: Clinical pathway; Health belief model; Melanoma; Patient compliance; Screening