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

描述（由申请人提供）：基于人群的登记研究记录了黑色素瘤的生存率，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例死亡，取决于黑色素瘤的厚度。通过促进寻求医疗保健，皮肤自我检查（SSE）的个人与黑色素瘤的历史，谁是在风险发展为随后的黑色素瘤，可能会导致早期发现和治疗黑色素瘤时，它通常是更有效的。因此，进一步的研究，提高早期检测是必要的，我们的应用程序直接测试新的方法，培训高风险黑色素瘤患者及其合作伙伴如何进行SSE，以促进早期检测。我们提出的研究建立在R21的优势之上，即：a）确定了与合作伙伴进行SSE的面对面培训在干预后4个月显著增强了SSE绩效，以及B）开发并试点测试了手动带回家的工作簿培训方法（工作簿）。我们与合作伙伴一起对工作手册进行的试点工作表明，患者-合作伙伴二人组（n = 21）认为它是可读的，有用的，并且在短期内4个月的随访中，与面对面合作伙伴培训条件下的患者-合作伙伴二人组（n = 19）相比，在促进SSE知识，技能和行为方面具有经验等效性。我们提出的研究建立在我们的NCI资助的研究基础上，通过对430名受试者进行正式检查，这些受试者被随机分配到面对面或练习册培训组，而对照组仅接受为期2年的标准护理，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期黑色素瘤患者的新方法，这些患者的5年生存率为80- 90%，他们的伴侣如何进行SSE。我们将比较患者和合作伙伴面对面培训与工作手册与对照组在SSE知识/技能获取和保留方面的有效性，以及SSE的性能和准确性。（基线后4和8个月）和长期基础（12、16、20、和基线后24个月），并检查伴侣-患者关系-质量调节培训方法与SSE知识/技能的获得和保持以及SSE性能和准确性之间的关系。建立健康促进伙伴关系对那些有发展黑色素瘤风险的人很重要，因为SSE作为一个个体很难成功地执行。预计该工作手册将促进SSE至少以及，也许比面对面的培训更好，并成为一个容易传播的SSE培训方法，不依赖于非MD临床办公室工作人员的时间和教学技能。 公共卫生相关性：据估计，近724，000名美国黑色素瘤幸存者每个病例有4个一级亲属;因此，与普通公众相比，280万美国人患黑色素瘤的风险增加。在这些人的合作伙伴的帮助下，SSE可以提高生存率。如果有效，本提案中测试的工作手册可以在医生办公室通过大规模手段分发给有患黑色素瘤风险的人。

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.