title: Influence of Quality of Relationship Between Patient With Melanoma and Partner on Partner-Assisted Skin Examination Education: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Melanoma has a high survival rate if it is detected early. Training patients with early-stage melanoma who are at risk of developing new melanomas to perform skin self-examination (SSE) may improve survival.
  
  
  OBJECTIVE
  To examine for whom the intervention works best in a sample composed of dyads of patients with melanoma and skin-check partners who received an SSE intervention vs customary care.
  
  
  METHODS
  For 494 patients with stage 0 to IIB melanoma (mean age, 55 years; 253 [51.2%] females) and their skin-check partners (mean age, 55 years; 280 [56.7%] females), a randomized clinical trial was conducted in ambulatory care dermatologic offices from June 6, 2011, to April 14, 2014. Follow-up assessments were performed at 12 months. Analysis was performed between March 23 and June 25, 2015.
  
  
  METHODS
  Dyads of 494 patients and their partners were randomly assigned to receive the intervention (395 patients) or customary care (control) (99 patients). The main outcome was patient SSE self-efficacy. Partner motivation to assist with SSE and relationship quality (eg, agreeability, activities with partner, and happiness) were assessed for moderation of the influence of the intervention's effect on SSE self-efficacy.
  
  
  RESULTS
  Relationship quality, defined by activities with the partner (β = -0.892, SE = 0.432, t = -2.066; P = .001) and happiness (β = -4.586, SE = 2.044, t = -2.24; P = .001), significantly moderated the intervention effects on patients' SSE self-efficacy. In contrast, patient-partner agreeability (β = -0.262, SE = 0.148, t = -1.773; P = .09) and partner motivation (β = -0.328, SE = 1.024, t = -0.320; P = .10) did not significantly moderate the intervention effects on patients' SSE self-efficacy. Differences between the conditions were highest when activities performed with the partner were below average (mean difference, 6.652; P = .001) and when happiness was below average (mean difference, 7.000; P = .001). Although everyone receiving the intervention experienced some benefit, the findings indicate the greatest increases in self-efficacy were observed for those with below-average activities performed with the partner and happiness.
  
  
  CONCLUSIONS
  The training of patients with melanoma and their partners in early-detection SSE benefited some more than others. Pairs who have low relationship quality, as determined by activities performed with the partner and happiness, may have received the greatest benefits from the training intervention because they were given an activity to perform together.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01432860.
authors.affiliation: Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park.
authors.forename: Brittney A
authors.initials: BA
authors.lastname: Hultgren
authors.affiliation: Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park.
authors.forename: Rob
authors.initials: R
authors.lastname: Turrisi
authors.affiliation: Prevention Research Center, The Pennsylvania State University, University Park.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Mallett
authors.affiliation: Prevention Research Center, The Pennsylvania State University, University Park.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ackerman
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Editor, JAMA Dermatology.
authors.forename: June K
authors.initials: JK
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009042:Motivation; D009367:Neoplasm Staging; D010353:Patient Education as Topic / Q000379:methods; D020377:Self Efficacy; D016353:Self-Examination / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis*; D018454:Spouses; D055815:Young Adult