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

描述(由申请人提供)：基于人口的登记文件表明，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例新黑色素瘤病例和约8,600人死亡。通过促进求医，有黑色素瘤病史的个人进行皮肤自我检查(SSE)可能会导致早期发现和治疗黑色素瘤，而这种检查通常更有效。因此，加强早期检测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合作伙伴如何进行SSE以促进早期检测的新方法。我们拟议的研究建立在R21的优势基础上：a)确定在干预后4个月与合作伙伴进行SSE的面对面培训显著提高SSE表现，以及b)开发和试点测试带回家的手动工作簿培训方法(工作簿)。我们与合作伙伴一起进行的工作簿试点工作表明，患者-伴侣DYAD(n=21)认为它是可读性的、有用的，并且在短期4个月的跟踪中，与面对面合作伙伴培训条件下(n=19)的患者-伙伴DYAD相比，在促进SSE知识、技能和行为方面经验上是相同的。我们建议的研究建立在我们NCI资助的研究的基础上，通过对430名受试者进行正式检查，这些受试者被随机分为面对面培训或练习本培训，而只接受评估的对照组接受了为期2年的纵向研究，间隔4个月进行评估。我们建议的研究直接测试培训I期和IIA期黑色素瘤患者及其伴侣如何进行SSE的新方法，这些患者的5年存活率为80%-90%。我们将在短期(基线后4个月和8个月)和长期(基线后12、16、20和24个月)的基础上比较针对患者和合作伙伴的面对面培训、SSE知识/技能获取和保留以及SSE绩效和准确性方面的有效性，并检查合作伙伴-患者关系质量是否会调节培训方法与SSE知识/技能获取和保留以及SSE绩效和准确性之间的关系。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作为一个个体很难成功地进行。预计工作手册将促进SSE，至少与面对面培训一样，甚至可能更好，并成为一种易于传播的SSE培训方法，不依赖于非MD临床办公室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名一级亲属；因此，与普通公众相比，280万美国人患黑色素瘤的风险更高。这些人在伴侣的帮助下进行SSE可以提高存活率。如果有效，在这项建议中测试的工作簿可以在医生办公室通过大规模的方式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.