Skin Cancer Prevention Counseling Research Articles

Incongruence between Physician, Patient, and Medical Chart Report of Skin Cancer Prevention Counseling.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. Skin cancer prevention counseling can lead to increased sun protective behavior and early detection; however, little is understood regarding the frequency and content of counseling among primary care providers (PCPs). We performed multi-center cross-sectional surveys among 53 providers and 3343 of their patients and chart review asking whether skin cancer prevention counseling occurred and details of that counseling. Only 10–25% of patients reported that counseling occurred. Among the providers who reported counseling, there were higher odds that their patients recollected they were advised to use sunscreen or protective clothing, on how to use sunscreen, on signs of skin cancer, to perform a self-skin exam (all p < 0.001), and were provided with written materials (p < 0.01). Eight percent of prevention counseling was chart documented despite being highly associated with patient and physician recollection of counseling (p < 0.001). These results highlight the need for consistent and clear delivery of skin cancer primary prevention.

Skin cancer prevention counseling in populations with elevated risk: An analysis of the Health Information National Trends Survey 5 Cycle 2

To the Editor: US physicians are recommended to selectively counsel adults older than 24 years with fair skin types about limiting ultraviolet radiation (UVR) exposure to reduce skin cancer risk.1 Individuals who use indoor tanning, have photosensitive skin, or have a history of skin cancer are at increased skin cancer risk.1,2 Although counseling can improve primary skin cancer prevention,3 barriers may prevent health care providers (HCPs) from doing so.4 We investigated whether individuals with skin cancer risk factors, versus those without, differed in terms of receiving advice from HCPs to limit UVR exposure.

Clinical counseling on sun protection and indoor tanning avoidance: A survey of current practices among U.S. health care providers

Clinicians can play a role in skin cancer prevention by counseling their patients on use of sun protection and indoor tanning avoidance. We used data from the 2016 DocStyles, a web-based survey of U.S. primary care providers, to examine skin cancer prevention counseling practices among 1506 providers. In 2018, we conducted logistic regression analyses to examine factors associated with regularly providing counseling. Almost half (48.5%) of all providers reported regularly counseling on sun protection, and 27.4% reported regularly counseling on indoor tanning. Provider characteristics associated with regular counseling included having practiced medicine for at least 16 years (sun protection: adjusted prevalence ratio [aPR] = 1.27, 95% confidence interval [CI] = 1.15, 1.41; indoor tanning: aPR = 1.38, 95% CI = 1.17, 1.63), having treated sunburn in the past year (sun protection: aPR = 1.78, 95% CI = 1.46, 2.17; indoor tanning: aPR = 2.42, 95% CI = 1.73, 3.39), and awareness of U.S. Preventive Services Task Force recommendations (sun protection: aPR = 1.73, 95% CI = 1.51, 2.00; indoor tanning: aPR = 2.70, 95% CI = 2.09, 3.48). Reporting barriers to counseling was associated with a lower likelihood of regularly counseling on sun protection (1–3 barriers: aPR = 0.82, 95% CI = 0.71, 0.94; 4+ barriers: aPR = 0.80, 95% CI = 0.69, 0.93) and indoor tanning (1–3 barriers: aPR = 0.72, 95% CI = 0.57, 0.91; 4+ barriers: aPR = 0.61, 95% CI = 0.47, 0.78). Barriers to counseling included lack of time (58.1%), more urgent health concerns (49.1%), and patient disinterest (46.3%). Although many providers report regularly counseling patients on skin cancer prevention, most report serious barriers to providing such counseling. Additional research could explore strategies to integrate compelling and informative skin cancer prevention counseling into current provider practices.

277 Discrepancies in skin cancer prevention counseling reported between patient, physician, and patient chart

277 Discrepancies in skin cancer prevention counseling reported between patient, physician, and patient chart

The Value of Behavioral Counseling for Skin Cancer Prevention

The Value of Behavioral Counseling for Skin Cancer Prevention

USPSTF Recommendations for Behavioral Counseling for Skin Cancer Prevention

USPSTF Recommendations for Behavioral Counseling for Skin Cancer Prevention

Sun Protection and Skin Self-examination and the US Preventive Services Task Force Recommendation on Behavioral Counseling for Skin Cancer Prevention

Sun Protection and Skin Self-examination and the US Preventive Services Task Force Recommendation on Behavioral Counseling for Skin Cancer Prevention

Skin cancer knowledge, attitudes, beliefs, and prevention practices among medical students: A systematic search and literature review.

BackgroundAs future physicians, medical students will play an important role in the prevention of skin cancers by becoming directly involved in skin cancer prevention education and counseling patients about the hazards of ultraviolet light.ObjectiveWe assessed the skin cancer-related knowledge, attitudes, beliefs, and prevention practices reported in previous studies of medical students.MethodsThe search for relevant articles was performed in four electronic databases: PubMed (Medline), Cumulative Index to Nursing and Allied Health, ERIC, and PsycINFO. Studies were included if they met the following criteria: 1) targeted medical students; 2) assessed sun avoidance, sun protection, skin self-examination, and/or indoor tanning behaviors; 3) were published in peer-reviewed journals; and 4) complete data were available for extraction.ResultsA total of 21 studies are included in this review. Important findings include moderate-to-high levels of skin cancer knowledge and low levels of both sunscreen and ultraviolet light knowledge. The attitudes and knowledge of medical students reflect a low level of concern with regard to the perceived importance of skin cancer compared with other forms of cancer despite a high level of concern for the importance of skin cancer prevention. Furthermore, this review demonstrated that medical students fail to protect themselves routinely from the sun and have a high interest in tanning bed use.ConclusionThis review demonstrates the need to educate medical students about skin cancer and skin cancer preventive behaviors. New strategies and educational campaigns should be developed to communicate better information on skin cancer morbidity, mortality, and prevention to medical students. This will pay dividends by improving the practice of these future physicians in all specialties.

An Online Intervention to Enhance Nurse Practitioners’ Skin Cancer Knowledge, Attitudes, and Counseling Behaviors

ABSTRACT The purpose of this pilot study was to determine whether a brief educational video administered online improved nurse practitioners’ knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. Participants completed an online test assessing knowledge, attitudes, and behaviors, before and after viewing an online video. Thirty Arizona nurse practitioners completed the pilot study. There were statistically significant increases from the pretest to the posttest for all main variables. This pilot study found that the online intervention was highly effective for improving nurse practitioners’ knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling.

Task Force endorses limited skin cancer prevention counseling

Task Force endorses limited skin cancer prevention counseling

Ultraviolet photography as a skin cancer risk assessment and intervention tool

I n the Gamble et al study in this issue, the authors conducted a comprehensive study assessing the relationship between severity of sun damage in ultraviolet (UV) photographs with phenotypic melanoma risk factors in a large population of 12-yearold children. They found that indeed the severity of sun damage in UV photography correlates closely with phenotypic melanoma risk factors such as freckling and skin color, yet standard visible light photography did not. Skin cancer primary prevention needs to start with the younger-aged populations. As with other prevention strategies, the earlier in life preventive behaviors begin, the more likely they will be practiced in adulthood. Ultimately, UV photography could be used as a risk assessment tool in primary care physicians’ offices for younger patients and therefore aid in tailoring appropriate skin cancer prevention counseling efforts. There have been many other risk assessment tools developed, such as the risk of malignancy tool in ovarian cancer, or even the body mass index used so frequently in pediatric practices. Increased body mass index is associated with many health risks including various cancers. It is an example of a simple tool that only takes a couple minutes of nursing or medical assistant time (and is therefore low cost), yet it is highly predictive of many future health outcomes. UV photography could be quickly used in a similar fashion in dermatologists’ or general practitioners’ offices when the patient is checked in. However, there may be clinical practice barriers to its widespread use as a result of the costs of such equipment

Skin Cancer Knowledge and Prevention Counseling Among Arizona Pharmacists

Skin cancer is particularly prevalent in Arizona, with incidence rates ranking number 2 worldwide. This study assessed pharmacists’ knowledge of skin cancer and factors that impacted skin cancer prevention patient counseling. Participants were recruited using a listserv of pharmacists that were members of the Arizona Pharmacy Alliance (AzPA) or preceptors of the University of Arizona College of Pharmacy. Subjects completed an online questionnaire consisting of knowledge-based questions, questions about patient counseling preferences, and subject demographics. The mean correct score on the Skin Cancer and Sun Exposure Knowledge Indicator was 5.8 ± 1.9. Pharmacists living in Arizona for longer duration were more likely to know the minimum recommended sunscreen sun protection factor (SPF) for adults when outdoors (P = .003) and factors associated with malignant melanoma prognosis/survival (P = .004) but were less likely to know the definition of ABCD acronym (P = .027). Having a family or friend diagnosed with any form of skin cancer or precancerous skin condition led to more pharmacists knowing the risk factors for developing melanoma (P = .046) and knowing how often to apply water resistant sunscreen (P = .035). In conclusion, the length of pharmacy practice in Arizona and having a family member or close friend affected by skin cancer significantly impacted a pharmacists’ knowledge of skin cancer.

Rates of Skin Cancer Screening and Prevention Counseling by US Medical Residents

To determine factors related to residents' self-reported skill level for the skin cancer examination (SCE). Survey of residents in November 2003. Four US residency programs. Medical residents in family medicine, pediatrics, obstetrics and gynecology, and internal medicine and specialists. Proportion of residents reporting their current skill level for the performance of the SCE. Of 454 surveys distributed, 342 residents completed the survey (75.3% response rate). Clinical training for the SCE during residency was infrequent. During residency, 75.8% were never trained in the SCE, 55.3% never observed an SCE, and 57.4% never practiced the examination. Only 15.9% of residents reported being skilled in the SCE. However, the conduct of 4 SCEs (or slightly more than 1 per each year of residency) was associated with manifold increases in self-reported skill levels. Information now collected from 7 medical schools and 4 residency programs underscores the need for more supervised opportunities to enable physicians in training to perform an SCE during routine patient examinations.

The benefits of skin cancer prevention counseling for parents and children

In the accompanying commentary, Dr Boyd explains that his decision to stop counseling patients about sun protection stems from his perception that the public is fully informed about the risks of UV radiation and that physician advice meets with little success. It is our contention that the data do not support his first assumption–in fact there is much that we do not know about the public's knowledge of risks of exposure from artificial or natural light and that, although the effect of physician advice may be limited, it is nonetheless important.

Overcoming Obstacles to Skin Cancer Examinations and Prevention Counseling for High-Risk Patients: Results of a National Survey of Primary Care Physicians

Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices. In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, internists, and general practitioners sampled from the American Medical Association's Medical Marketing Services' database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35. We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination (P < .01). Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

Freqüência de aconselhamento para prevenção de câncer da pele entre as diversas especialidades médicas em Caxias do Sul

FUNDAMENTOS: O câncer da pele é a forma mais comum de câncer atualmente, apesar de ser um dos mais preveníveis. Não foram encontrados dados na literatura nacional quanto à freqüência de orientação para prevenção desse tipo de câncer de acordo com as diversas especialidades médicas. OBJETIVOS: O objetivo do trabalho foi verificar a freqüência de aconselhamento para prevenção de câncer da pele entre as diversas especialidades médicas em uma amostra da população de Caxias do Sul. MÉTODOS: Trata-se de um estudo transversal. Foram entrevistadas e examinadas 499 pessoas que procuraram atendimento na área de dermatologia em ações comunitárias realizadas em Caxias do Sul de janeiro a julho de 2002. RESULTADOS: Apenas 31,9% (n=159; IC 27,8 - 36,2) das pessoas entrevistadas já haviam recebido aconselhamento pela classe médica para prevenção de câncer da pele. Os pacientes de alto risco com o maior potencial para intervenção, ou seja, pacientes com idade inferior a 20 anos, receberam orientação em freqüência menor do que os pacientes com 20 anos ou mais (26,5% versus 42,5%, respectivamente; p = 0,03). A especialidade de dermatologia foi responsável por mais da metade dos aconselhamentos para prevenção de câncer da pele na população estudada. CONCLUSÃO: A freqüência de aconselhamento para prevenção de câncer da pele pelos profissionais da saúde é baixa, mesmo para os pacientes de alto risco. A orientação também varia de acordo com a especialidade consultada, tendo apenas a especialidade de dermatologia apresentado alta freqüência de aconselhamento.

Skin cancer prevention counseling and clinical practices of pediatricians.

Little is known about pediatricians' counseling and clinical practices to reduce skin cancer risk among their patients. Thus our objectives were to characterize skin cancer preventive counseling and clinical practices in a sample of pediatricians and identify correlates of these practices. Physicians practicing general pediatrics in Harris County, Texas, received a mail survey that assessed their sun protection recommendations and skin cancer preventive counseling and clinical practices. Pediatrician, patient, and medical practice variables were assessed as correlates. Most (76%) pediatricians routinely recommended sunscreen; however, relatively few (24%) suggested reapplying it after prolonged periods outside. About half routinely recommended protective clothing (53%), shade (47%), or limiting midday sun exposure (46%). Even fewer pediatricians routinely discussed skin cancer risk factors, passed out sunscreen samples, made educational materials available, took a family history of skin cancer, or documented risk factors in a patient's chart. More than half reported that they routinely performed full-body skin examinations during a first visit (65%) and annually (56%). Perceived barriers, perceived relevance of skin cancer prevention, and personal sun protection practices were important factors associated with professional practices in this sample. Interventions are needed to increase pediatricians' counseling and clinical practices to reduce skin cancer risk among patients.

The impact of the basic skin cancer triage curriculum on provider's skin cancer control practices.

To evaluate the effect of a 2-hour, multicomponent educational intervention on provider skin cancer control practices. Nonrandomized intervention study. The intervention was a 2-hour curriculum designed to augment provider skin cancer control practices through instruction in basic skin cancer triage (BSCT) and a brief summary of skin cancer epidemiology, prevention, and counseling. Five staff-model health maintenance organizations in southeastern New England. Convenience sample of primary care providers. Providers older than age 75, individuals in practice for less than 1 year, or individuals planning to retire in the next 2 years were excluded from the study. Twenty-two of 28 participants completed the study. Providers completed preintervention and postintervention surveys asking them to rate their attitudes towards skin examination and skin cancer counseling and to rate the frequency of their skin cancer control practices, using 5-point Likert scales. We independently assessed provider behavior through surveys of their patients, eliciting information on provider practices before and after BSCT participation. Following participation in the curriculum, there was significant improvement in provider attitudes towards the total body skin examination but not towards skin cancer prevention counseling. Significant increases in provider self- reported skin cancer control practices during an initial visit with a new patient (2.17 to 3.21, P <.0001) and a routine visit with a patient at high risk for melanoma (2.15 to 3.00, P <.0001) were demonstrated. Analysis of the patient exit interviews independently confirmed these changes in practice patterns. The study results suggest that the BSCT curriculum may be a useful tool in increasing the practice of skin cancer control measures by primary care providers.

Skin examinations and skin cancer prevention counseling by US physicians: A long way to go

Background: Nonmelanoma skin cancer and actinic keratoses may be partially preventable by physician counseling. Objective: The purpose of this study was to assess the frequency of counseling for skin cancer prevention. Methods: Data on skin cancer counseling and skin examinations were obtained from representative visits to outpatient physicians in the United States from the 1997 National Ambulatory Medical Care Survey. A limitation of the skin examination data is that the extent of the skin examination was not reported. Results: Skin examinations occurred in 60 million (8.6%) of 703 million office visits, and skin cancer prevention counseling or education occurred in 12 million visits (1.5%). For patients younger than 20 years, such prevention counseling occurred in only 1.0% of 169 million visits. For those patients with a current or previous history of nonmelanoma or melanoma skin cancer or actinic keratosis (high-risk patients) identified by the treating physician, 2.8 million (35%) of 7.9 million patients received such counseling. In high-risk patients, dermatologists provided such counseling at 41% of visits, compared with 24% for general and family practice, 9.3% for otolaryngology, 13% for general surgery, and 7.7% for internal medicine. In such high-risk patients, skin examinations were performed at 78% of dermatology visits, 69% of otolarynogolgy visits, 36% of general surgery visits, and 27% of family physician visits. Capitation did not lead to greater primary preventive practices; skin cancer prevention counseling occurred in 4% of high-risk capitated patients compared with 38% of noncapitated patients. Conclusion: Physicians provide skin cancer prevention counseling or education at fewer than half of visits for high-risk patients. High-risk patients are likely to receive skin cancer prevention messages depending on the specialty of physician that they visit in roughly the following scheme: dermatologists>family physicians>all other specialties. Economic restraints within managed care systems may affect their “health maintenance” function. (J Am Acad Dermatol 2000;43:234-7.)

Reports by patients and dermatologists of skin cancer preventive services provided in dermatology offices.

To learn how often patients receive skin cancer preventive services in dermatologists' offices. Survey of dermatology patients and dermatologists. Dermatology practices of full-and part-time faculty at a midwestern medical school. Patients were randomly selected from clinical sessions of 11 dermatologists. Of 200 patients enrolled, 162 (81%) responded to the survey. Ten (91%) of the dermatologists responded, and 4 additional dermatologists from the faculty were also surveyed. Patients' and dermatologists' reports of the provision of skin cancer prevention counseling and screening for skin cancer. Most patients (93%) had been informed about the risks of sun exposure, but for only 27% was a dermatologist the main source of information. Although 76% of patients had seen a dermatologist at least twice in the last 5 years, only 34% reported that they had ever received a total-body screening examination for skin cancer. Most patients (55%) would like to learn more about skin cancer prevention, and responded that they would learn best from a brochure (43%) or from a dermatologist (42%). All dermatologists believed that some skin cancer preventive services should be provided to each patient, but they varied widely in the proportion of their white adult patients to whom they provided such services. For example, with respect to counseling about sunscreens, the same number of dermatologists (4 [29%]) responded that they counsel 25% or less of their patients, and more than 75% of their patients. There is wide variation in how often skin cancer preventive services are provided in dermatologists' offices.