title: Use of support services in a sample of patients with high-risk primary melanomas in urban, regional and rural Queensland.
abstract: OBJECTIVE
  To characterise use of support services in patients diagnosed with high-risk primary melanoma by their location of residence.
  
  
  METHODS
  In a cross-sectional study of 787 patients with histologically-confirmed clinical stage 1B-2 melanoma, we estimated odds ratios (ORs) using regression models to assess the association of support service use with residence in rural, regional or urban areas. We also evaluated demographic and clinical correlates of support service use.
  
  
  RESULTS
  Among 113 rural patients, 33 (29%) used support services around time of diagnosis compared to 88 (39%) of 224 regional participants and 164 of 448 (37%) urban participants. Regional participants more commonly used support services compared to rural participants (OR 1.84; CI 1.09-3.10), but there was no association with urban versus rural residence (OR 1.32; CI 0.82-2.13). As well, females (OR 1.58; CI 1.15-2.18), those <65 years (OR 1.96; CI 1.42-2.71), or with higher education (OR 2.30; CI 1.53-3.44), or those with T-stage 4B (OR 2.69; CI 1.36-5.32) were more likely to use support services than other patients.
  
  
  CONCLUSIONS
  Use of support services is lower among rural patients and other sub-groups of primary melanoma patients who have poorer prognoses than others. Implications for public health: Appropriate triage to support services is required for rural and other vulnerable patient groups to ensure optimal patient care.
authors.affiliation: School of Public Health, The University of Queensland.|QIMR Berghofer Institute of Medical Research, Queensland.
authors.forename: Lena A
authors.initials: LA
authors.lastname: von Schuckmann
authors.affiliation: Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland.
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Smithers
authors.affiliation: UQ Centre for Clinical Research, Queensland.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Khosrotehrani
authors.affiliation: QIMR Berghofer Institute of Medical Research, Queensland.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Beesley
authors.affiliation: School of Public Health, The University of Queensland.|QIMR Berghofer Institute of Medical Research, Queensland.
authors.forename: Jolieke C
authors.initials: JC
authors.lastname: van der Pols
authors.affiliation: QIMR Berghofer Institute of Medical Research, Queensland.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Hughes
authors.affiliation: QIMR Berghofer Institute of Medical Research, Queensland.|CRUK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, UK.
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057226:Information Seeking Behavior; D007255:Information Services; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D011446:Prospective Studies; D011793:Queensland; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D012944:Social Support; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014505:Urban Population
keywords: Queensland; high-risk patients; melanoma; remoteness of residence; support services