A comparison of interventions to teach melanoma patients' skin self-examination

描述（由申请人提供）：基于人口的登记记录表明，黑色素瘤的存活率取决于黑色素瘤的厚度。黑色素瘤是一个日益严重的公共卫生问题，2010年约有70,000例新发黑色素瘤病例，估计有8,600人死亡。通过促进寻求医疗护理，有黑素瘤病史的个体的皮肤自我检查（sse）可能导致黑素瘤的早期发现和治疗，而黑素瘤通常更有效。因此，加强早期发现的进一步研究是有必要的，我们的应用直接测试了培训高危黑色素瘤患者及其伴侣如何进行sse以促进早期发现的新方法。我们提出的研究建立在R21的优势之上：a)建立了与合作伙伴进行SSE的亲自培训，在干预后4个月显著提高了SSE绩效，b)开发并试点了一种手工带回家的工作手册培训方法（workbook）。我们与合作伙伴对工作手册进行的试点工作表明，与面对面合作伙伴培训条件下的合作伙伴（n = 19）相比，患者-伴侣二人组（n = 21）认为工作手册可读、有用，并且在4个月的短期随访中，在促进SSE知识、技能和行为方面具有经验上的同等作用。我们提出的研究建立在NCI资助的研究基础上，通过对430名受试者进行正式检查，随机分为面对面或工作手册培训，与仅接受标准护理的对照组进行为期2年的纵向研究，间隔4个月进行评估。我们提出的研究直接测试了培训I期和IIA期黑色素瘤患者（5年生存率为80-90%）及其伴侣如何进行ssi的新方法。我们将比较在人的培训与工作簿的功效为病人和合作伙伴与控制SSE知识/技能获取和保留,和SSE性能和准确性在短(4和8个月后基线)和长期的基础(12、16、20和24个月后基线)并检查是否partner-patient relationship-qualities温和的训练方法和学生之间的关系的知识/技能获取和保留,和SSE性能和准确性。建立健康促进伙伴关系对那些有患黑色素瘤风险的人很重要，因为SSE很难作为个体成功执行。预计工作手册将至少与现场培训一样，甚至可能更好地促进SSE培训，并成为一种易于传播的SSE培训方法，不依赖于非医学博士临床办公室员工的时间和教学技能。

DESCRIPTION (provided by applicant): Population based registries document that survival from melanoma, a growing public health problem with approximately 70,000 new melanoma cases and an estimated 8,600 deaths in 2010, is dependent on the thickness of the melanoma. By facilitating seeking medical care, skin self-examinations (SSEs) by individuals with a prior history of melanoma, who are at risk to develop subsequent melanomas, may lead to the early detection and treatment of melanoma when it is usually more effective. Thus, further research that enhances early detection is warranted and our application directly tests novel methods of training high-risk melanoma patients and their partners on how to conduct SSEs to promote early detection. Our proposed research builds upon the strengths of the R21 that: a) established that in-person training to conduct SSE with a partner significantly enhanced SSE performance 4 months after the intervention, and b) developed and pilot tested a manual take-home workbook training approach (WORKBOOK). Our pilot work on the WORKBOOK with partners suggests that patient-partner dyads (n = 21) perceived it to be readable, useful, and in the short term 4 month follow-up, empirically equivalent in promoting SSE knowledge, skills, and behaviors compared with patient-partner dyads in the in-person partner training condition (n = 19). Our proposed research builds on our NCI funded studies by conducting a formal examination with 430 subjects randomized to either the in-person or workbook training vs. an assessment only control group that receives standard of care over a 2 year longitudinal study with 4 month interval evaluations. Our proposed research directly tests novel methods of training Stage I and IIA melanoma patients, who have a 5 year survival of 80-90%, and their partners, on how to conduct SSEs. We will compare the efficacy of the in- person training vs. workbook for patients and partners vs. controls on SSE knowledge/skill acquisition and retention, and SSE performance and accuracy on a short (4 and 8 months post baseline) and long term basis (12, 16, 20, and 24 months post baseline) and examine whether partner-patient relationship-qualities moderate the relationship between the training approaches and SSEs knowledge/skill acquisition and retention, and SSE performance and accuracy. Establishing health promotion partnerships is important to those at risk to develop melanoma because SSE is difficult to successfully perform as an individual. It is expected that the workbook will promote SSE at least as well as and perhaps better than in-person training and become an easily disseminated SSE training approach that is not dependent on the time and teaching skills of the non-MD clinical office staff. PUBLIC HEALTH RELEVANCE: The almost 724,000 Americans survivors of melanoma are estimated to have 4 first degree relatives per case; thus, 2.8 million Americans are at increased risk of developing melanoma in comparison to the general public. SSE with the assistance of a partner by these individuals could improve survival. If effective, the workbook tested in this proposal could be distributed to people at risk of developing melanoma by large scale means in physician offices.