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Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

BACKGROUND: The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of le...

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Autores principales: Drabarek, Dorothy, Habgood, Emily, Ackermann, Deonna, Hersch, Jolyn, Janda, Monika, Morton, Rachael L, Guitera, Pascale, Soyer, H Peter, Collgros, Helena, Cust, Anne E, Saw, Robyn PM, Emery, Jon, Mar, Victoria, Dieng, Mbathio, Azzi, Anthony, Lilleyman, Alister, Bell, Katy JL
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334935/
https://www.ncbi.nlm.nih.gov/pubmed/37632906
http://dx.doi.org/10.2196/40623
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author Drabarek, Dorothy
Habgood, Emily
Ackermann, Deonna
Hersch, Jolyn
Janda, Monika
Morton, Rachael L
Guitera, Pascale
Soyer, H Peter
Collgros, Helena
Cust, Anne E
Saw, Robyn PM
Emery, Jon
Mar, Victoria
Dieng, Mbathio
Azzi, Anthony
Lilleyman, Alister
Bell, Katy JL
author_facet Drabarek, Dorothy
Habgood, Emily
Ackermann, Deonna
Hersch, Jolyn
Janda, Monika
Morton, Rachael L
Guitera, Pascale
Soyer, H Peter
Collgros, Helena
Cust, Anne E
Saw, Robyn PM
Emery, Jon
Mar, Victoria
Dieng, Mbathio
Azzi, Anthony
Lilleyman, Alister
Bell, Katy JL
author_sort Drabarek, Dorothy
collection PubMed
description BACKGROUND: The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). OBJECTIVE: This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. METHODS: This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP–led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of “medical overuse” and “high-value care.” RESULTS: Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. CONCLUSIONS: Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy; however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12616001716459; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865
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spelling pubmed-103349352023-07-18 Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study Drabarek, Dorothy Habgood, Emily Ackermann, Deonna Hersch, Jolyn Janda, Monika Morton, Rachael L Guitera, Pascale Soyer, H Peter Collgros, Helena Cust, Anne E Saw, Robyn PM Emery, Jon Mar, Victoria Dieng, Mbathio Azzi, Anthony Lilleyman, Alister Bell, Katy JL JMIR Dermatol Original Paper BACKGROUND: The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). OBJECTIVE: This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. METHODS: This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP–led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of “medical overuse” and “high-value care.” RESULTS: Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. CONCLUSIONS: Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy; however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12616001716459; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865 JMIR Publications 2022-12-20 /pmc/articles/PMC10334935/ /pubmed/37632906 http://dx.doi.org/10.2196/40623 Text en ©Dorothy Drabarek, Emily Habgood, Deonna Ackermann, Jolyn Hersch, Monika Janda, Rachael L Morton, Pascale Guitera, H Peter Soyer, Helena Collgros, Anne E Cust, Robyn PM Saw, Jon Emery, Victoria Mar, Mbathio Dieng, Anthony Azzi, Alister Lilleyman, Katy JL Bell. Originally published in JMIR Dermatology (http://derma.jmir.org), 20.12.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Drabarek, Dorothy
Habgood, Emily
Ackermann, Deonna
Hersch, Jolyn
Janda, Monika
Morton, Rachael L
Guitera, Pascale
Soyer, H Peter
Collgros, Helena
Cust, Anne E
Saw, Robyn PM
Emery, Jon
Mar, Victoria
Dieng, Mbathio
Azzi, Anthony
Lilleyman, Alister
Bell, Katy JL
Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title_full Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title_fullStr Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title_full_unstemmed Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title_short Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study
title_sort perspectives and experiences of patient-led melanoma surveillance using digital technologies from clinicians involved in the mel-self pilot randomized controlled trial: qualitative interview study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334935/
https://www.ncbi.nlm.nih.gov/pubmed/37632906
http://dx.doi.org/10.2196/40623
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