JMIR Publications

ABSTRACT

Background:

After treatment for a localised melanoma, patients attend routinely scheduled clinics to monitor for new primary or recurrent melanoma. Patient-led surveillance (skin self-examination with patient-performed teledermoscopy) is an alternative model of follow-up that could replace some routinely scheduled visits.

Objective:

To assess the acceptability of a hypothetical reduction in routinely scheduled visits among participants of the MEL-SELF pilot randomized clinical trial of patient-led surveillance (intervention) versus usual care (control).

Methods:

Patients previously treated for localised melanoma in New South Wales who were participating in the MEL-SELF pilot RCT were asked to respond to an online questionnaire at baseline and after 6 months on-trial. We used mixed methods to analyze the data. Main Outcome: Acceptability of a hypothetical reduction in routinely scheduled visits for melanoma surveillance.

Results:

Of 100 randomized participants, 87 answered the questionnaire at baseline, 66 answered the questionnaire at 6 months, and 79 provided a free text explanation at either time point. At 6 months, 33% of the intervention group and 35% of the control group indicated a hypothetical reduction in routinely scheduled visits with all melanoma doctors was at least slightly acceptable (difference in proportions: -1%; 95%CI: -20% to 17%). Participants suggested that pre-requisites for a reduction in routinely scheduled visits would include that: sufficient time had elapsed since the previous diagnosis without a new primary melanoma or recurrence; an unscheduled appointment could be made at short notice if the patient noticed something concerning; their melanoma doctor had suggested reducing visit frequency, and patients had confidence that patient-led surveillance was a safe and effective alternative. Participants suggested a reduction in routinely scheduled visits would not be acceptable where they perceived: a very high risk of new or recurrent melanoma, low self-efficacy in skin self-examination and in the use of technologies for the patient-led surveillance intervention, and preference for clinician-led surveillance. Some patients said that a partial reduction to once a year may be acceptable.

Conclusions:

Some patients may be receptive to a reduction in routinely scheduled visits if they were assured that patient-led surveillance was safe and effective. Clinical Trial: http://anzctr.org.au Identifier: ACTRN12616001716459