Implementing systematic melanoma risk assessment and risk-tailored surveillance in a skin cancer focussed dermatology clinic: A qualitative study of feasibility and acceptability to patients and clinic staff

A L Smith; A K Smit; B I Laginha; N Singh; B Gallo; L Martin; A E Cust

doi:10.1002/cam4.6976

Implementing systematic melanoma risk assessment and risk-tailored surveillance in a skin cancer focussed dermatology clinic: A qualitative study of feasibility and acceptability to patients and clinic staff

Cancer Med. 2024 Jan;13(2):e6976. doi: 10.1002/cam4.6976.

Authors

A L Smith¹, A K Smit^{1

2

3}, B I Laginha⁴, N Singh^{1

4}, B Gallo², L Martin^{2

5}, A E Cust^{1

2

3}

Affiliations

¹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.
² Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
³ Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁵ Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

Background: International bodies recommend that melanoma risk assessment should be integrated into skin cancer care provision, but evidence to support implementation is lacking.

Aim: To explore the acceptability and feasibility of implementing personalised melanoma risk assessment and tailored patient education and skin surveillance within routine clinical care.

Methods: This prospective qualitative implementation study was informed by the Theoretical Framework of Acceptability (TFA). Personalised, systematic melanoma risk assessment was implemented in the dermatology clinic at the Melanoma Institute Australia, Sydney, Australia February-May 2021. Pre- and post-implementation observations and semi-structured interviews with patients and staff were conducted (September 2020-March 2021). Observational notes and interview transcript data were analysed thematically using the TFA as a classifying framework.

Results: A total of 37 h of observations were made, and 29 patients and 12 clinic staff were interviewed. We found that the delivery of personalised melanoma risk estimates did not impact on patient flow through the clinic. Dermatologists reported that the personalised risk information enhanced their confidence in assessing patient risk and recommending tailored surveillance schedules. Most patients reported that the risk assessment and tailored information were a beneficial addition to their care. Among patients whose risk deviated from their expectations, some reported feeling worried, confused or mistrust in the risk information, including those at lower risk who were recommended to decrease surveillance frequency.

Conclusions: It is feasible and acceptable to patients and clinic staff to calculate and deliver personalised melanoma risk information and tailored surveillance as part of routine clinical care within dermatology clinics.

Keywords: early detection; implementation science; melanoma; risk assessment; screening; skin cancer; surveillance.

MeSH terms

Dermatology*
Feasibility Studies
Humans
Melanoma* / diagnosis
Melanoma* / epidemiology
Prospective Studies
Risk Assessment
Skin Neoplasms* / diagnosis
Skin Neoplasms* / epidemiology

Abstract

MeSH terms

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