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

摘要 随着黑色素瘤发病率在过去45年中增加了两倍多，美国黑色素瘤幸存者的人数 估计有100多万人。幸存者复发和新的初选风险增加 癌症。大多数复发的黑色素瘤是幸存者自己发现的，这就是为什么医生们 幸存者谈到定期、彻底的皮肤自检(SSE)的重要性，以及为什么专业指南 随访监测建议定期、彻底(SSE)。超过三分之二的黑色素瘤幸存者没有 执行定期、彻底的SSE。为了解决这个重大问题，我们经验丰富的团队开发了一种数字 这项名为mySmartSkin(MSS)的干预措施在新泽西州的一项随机对照试验中进行了测试。MSS 说明了对彻底的SSE有希望的效果。在这个应用中，我们建议为大规模的MSS做准备 使用创新的第一类混合有效性的传播--实施试验。一种1型混合动力车 有效性-实施设计使我们能够在整个研究过程中与多层次的利益相关者接触 流程，评估增强的MSS的有效性，并确定大范围的关键因素 实施。这项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KEY合作，使用多层次的利益相关者参与来增强MSS 利益相关者通过定性访谈和潜在增强的可用性测试来增强MSS。 潜在的增强基于经验验证的行为改变技术(BCT)和发现 来自我们之前的研究。我们将利用一个迭代过程，包括关键线人对幸存者的采访， 提供商和相关专业组织有关建议的增强功能，转换为 增强的基于移动的干预交付平台、与幸存者的可用性测试以及迭代计划 精益求精。目标2比较增强的MSS与非交互式教育网页在以下方面的效果 通过两个州癌症登记和社交媒体招募幸存者的RCT中的全面SSE 300例。在目标3中，我们确定了与未来扩大广泛传播有关的因素，并 使用混合方法评估区域工作队选定的执行成果，并探讨 幸存者、护理提供者和专业组织关于如何最好地传播和 在大范围内实施MSS。我们将估算项目成本并评估MSS的成本效益。这 该项目解决了黑色素瘤幸存者护理方面的一个有记录的缺口，方法是增强有希望的 面向幸存者的干预措施，并积极确定今后执行工作的障碍和促进者。我们 创新地“为传播而设计”，确保改进措施的设计符合目标人群 潜在用户的数量。作为优化前景看好的全自动化癌症在线干预措施的典范 对于幸存者的传播，该项目将提供关于潜在成本效益方法的重要信息 向幸存者提供帮助，以及如何使这种干预措施适用于传播。

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.