Accepted for/Published in: JMIR Dermatology
Date Submitted: Dec 23, 2021
Date Accepted: Apr 18, 2022
Date Submitted to PubMed: Aug 26, 2023
Experiences of patient-led surveillance, including patient-performed teledermoscopy, in the MEL-SELF pilot randomised controlled trial: Qualitative Interview Study
ABSTRACT
Background:
Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce healthcare use and costs, increase access to care and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation.
Objective:
We aimed to explore patients’ experiences and perceptions of patient-led surveillance during the six months of participating in the MEL-SELF pilot randomised controlled trial. Patient-led surveillance comprised regular skin self-examination (SSE), use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review.
Methods:
Semi-structured interviews were conducted with patients previously treated for a melanoma localised to the skin, in New South Wales, Australia, who were who were randomised to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyse the data with reference to the Technology Acceptance Model (TAM).
Results:
We interviewed 20 patients (8 women and 12 men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved SSE practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow up. Difficulty taking clear images and technical problems with the app were experienced by most participants. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness.
Conclusions:
Melanoma patients are receptive to, and experience benefit from, patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realise the full potential benefits of this new model of melanoma surveillance. Clinical Trial: Australian and New Zealand Clinical Trials Registry, ACTRN12616001716459
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