A digital intervention to improve skin self-examination among melanoma survivors

摘要 随着发病率在过去45年中增加了两倍多，美国黑色素瘤幸存者的人数 估计超过一百万人。生存者复发和新的原发灶的风险增加。 癌的大多数复发性黑色素瘤是由幸存者自己发现的，这就是为什么医生教育 幸存者关于定期，彻底的皮肤自我检查（SSE）的重要性，以及为什么专业指南 建议定期、彻底的随访监测（SSE）。超过三分之二的黑色素瘤幸存者没有 定期进行全面的自我安全检查为了解决这一重大问题，我们经验丰富的团队开发了一个数字 干预，称为mySmartSkin（MSS），并在随机对照试验中对新泽西的常规护理进行了测试。MSS 说明了对彻底的SSE有希望的影响。在这个应用中，我们建议准备MSS用于大规模的 使用创新的1型混合有效性-实施试验进行传播。一型混合动力车 有效实施设计使我们能够在整个研究过程中参与多层次的利益相关者 过程，评估增强的MSS的有效性，并确定大规模的关键因素 实施.该研究的三个目标是由实施框架和行为改变指导的 理论在目标1中，我们将通过与主要利益相关者合作， 通过定性访谈和对潜在增强功能的可用性测试，帮助利益攸关方增强管理支助系统。 潜在的增强功能基于经验证的行为改变技术（BCT）和发现 我们之前的研究。我们将利用一个迭代过程，其中包括与幸存者的关键线人访谈， 供应商和相关专业组织就拟议的增强功能、转换为 增强的基于移动的干预提供平台，对幸存者进行可用性测试，以及迭代程序 改进。目标2比较增强的MSS与非交互式教育网页对 通过两个州癌症登记处和社交媒体招募幸存者的RCT中的综合SSE （N=300）。在目标3中，我们确定了与未来扩大规模以广泛传播有关的因素， 使用混合方法评估RCT的选定实施结果，并探索 幸存者、护理提供者和专业组织关于如何最好地传播和 广泛实施管理支助服务。我们将估算项目成本并评估MSS的成本效益。这 一个项目通过增强一种有希望的治疗方法的效果，解决了黑色素瘤幸存者护理方面的记录差距。 面对幸存者的干预措施，并积极主动地确定未来实施的障碍和促进因素。我们 创新地“为传播而设计”，确保针对目标人群设计改进措施 的潜在用户。作为优化有前途的全自动在线癌症干预的模型 该项目将提供重要信息，说明可能具有成本效益的方法， 我们需要了解如何接触幸存者以及如何调整这种干预措施以进行传播。

ABSTRACT With incidence rates more than tripling in the last 45 years, the population of melanoma survivors in the US is estimated at more than a million persons. Survivors are at elevated risk for recurrence and new primary cancers. Most recurrent melanomas are found by survivors themselves, which is why physicians educate survivors about the importance of regular, thorough skin self-exams (SSE) and why professional guidelines for follow-up surveillance recommend regular, thorough (SSE). More than two thirds of melanoma survivors do not perform regular, thorough SSE. To address this significant problem, our experienced team developed a digital intervention, called mySmartSkin (MSS), and tested it in an RCT against usual care in New Jersey. MSS illustrated promising effects on thorough SSE. In this application, we propose to prepare MSS for large-scale dissemination using an innovative Type 1 hybrid effectiveness-implementation trial. A Type 1 hybrid effectiveness-implementation design allows us to engage multilevel stakeholders throughout the research process, evaluate the effectiveness of the enhanced MSS, and identify critical factors for wide-scale implementation. The study’s three aims are guided by implementation frameworks and behavior change theories. In Aim 1, we will enhance MSS using multi-level stakeholder engagement by collaborating with key stakeholders in enhancing MSS through qualitative interviews and usability testing of potential enhancements. Potential enhancements are based on empirically-validated behavior change techniques (BCTs) and findings from our prior study. We will utilize an iterative process that includes key informant interviews with survivors, providers, and relevant professional organizations regarding proposed enhancements, conversion to an enhanced mobile-based intervention delivery platform, usability testing with survivors, and iterative program refinements. Aim 2 compares the effects of enhanced MSS vs. a non-interactive educational webpage on comprehensive SSE in an RCT with survivors recruited through two state cancer registries and social media (N=300). In Aim 3, we identify factors relevant to future scale-up for widespread dissemination and implementation using mixed methods to assess selected implementation outcomes from the RCT and explore perspectives from survivors, care providers, and professional organizations about how to best disseminate and implement MSS on a broad scale. We will estimate program costs and assess cost-effectiveness of MSS. This project addresses a documented gap in care for melanoma survivors by enhancing effects of a promising survivor-facing intervention and proactively identifying barriers and facilitators to future implementation. We innovatively “design for dissemination” by ensuring that enhancements are designed with the target population of potential users. Serving as a model for optimizing promising fully-automated online interventions for cancer survivors for dissemination, this project will provide important information about potentially cost-effective ways to reach survivors as well as about how to adapt such an intervention for dissemination.