Increasing skin self-examination after melanoma: an intervention using text and tablet delivery

Abstract

Background: Following treatment for melanoma, recurrence risk is high and it is recommended that patients perform regular total skin self-examination (TSSE). However TSSE practice is sub-optimal and reported barriers include lack of training, waning motivation and the time required. The Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed based on the Information-Motivation-Behavioural skills model (IMB) and Control Theory to tackle these barriers and to facilitate TSSE in people treated for melanoma. This study aimed to assess acceptability and feasibility. Methods: The tablet-based intervention provides TSSE information/video demonstration, text message prompts to perform TSSE and allows users to take and send photographs of skin changes to a nurse specialist for review/action. N=20 people previously treated for melanoma piloted the intervention. Intentions and self-efficacy to perform TSSE were reported, adherence was automatically recorded and participants were interviewed about usability and acceptability. Findings: Adherence was good (15 adhered well, 4 intermittently and 1 withdrew). Participants were positive about using technology to remind and instruct on TSSE, conducting it in their homes and getting feedback quickly. Symptoms were reported by 7 participants and 2/7 had further surgery as a result, one with recurrent melanoma. Participants’ intention (ns) and self-efficacy (p<.05) to perform TSSE increased. Discussion: The ASICA intervention was acceptable and feasible for most patients. ASICA may provide a valuable adjunct to standard melanoma follow up, helping to reinforce and sustain TSSE and to facilitate earlier detection of recurrence. It is now proposed to evaluate the intervention in a randomised controlled trial.