Tailored Intervention for Melanoma Patients' Families

描述(由申请人提供)：皮肤恶性黑色素瘤(CMM)是最致命的皮肤癌类型，其发病率正在以流行的比例增加。CMM既有初级预防方法，也有皮肤癌监测方法。由于从队列和病例对照研究中有大量证据表明黑色素瘤与阳光照射有关，因此一级预防包括限制太阳辐射暴露和涂抹防晒霜。由于皮损的厚度是预测预后的最佳指标，皮肤癌的全身皮肤检查(TCE)和皮肤自检(SSE)被认为可以增加发现较薄的黑色素瘤病变的机会，从而降低这种疾病的死亡率和发病率。然而，与支持其他癌症检测和预防实践的数据相比，支持定期皮肤癌监测的流行病学数据仍然不明确。因此，以平均风险人群为目标进行干预以改善皮肤癌监测做法可能为时过早。然而，可以提出一个强有力的理由，将预防和监测努力集中在黑色素瘤风险增加的亚群个体上。这些人将受益于有关健康行为变化的信息，这些信息可能会降低他们患黑色素瘤的风险。在拟议的研究中，我们将重点放在被诊断为黑色素瘤患者的一级亲属，他们有一个额外的风险因素(例如，金发)。研究表明，家庭成员很少注意防晒和皮肤癌监测。在预防健康模式和计划行为理论的指导下，我们已经能够阐明在高危家庭成员中起到紫外线防护和CMM监测实践中作用的关键态度因素。我们利用这些数据设计了一种针对黑色素瘤患者家庭成员的定制印刷和电话咨询干预。这项拟议研究的主要目的是改进我们的定制信息，并进行一项随机临床试验，测试定制印刷和电话咨询干预措施，对照现有最好的皮肤癌预防公共健康教育材料。我们将针对不符合TCE和最低限度执行SSE和防晒措施的家庭成员。396名家庭成员将完成这项研究。结果将根据TCE、SSE和防晒习惯以及对CMM的态度和知识的变化进行评估

DESCRIPTION (provided by applicant): The incidence of cutaneous malignant melanoma (CMM), the most deadly type of skin cancer, is increasing by epidemic proportions. There are both primary prevention methods and skin cancer surveillance methods for CMM. Because there is substantial evidence from cohort and case-control studies that melanoma is associated with sun exposure, primary prevention involves limiting exposure to solar radiation and applying sunscreen. Because thickness of the lesion is the best predictor of prognosis, skin cancer surveillance by total cutaneous examination (TCE) and skin self-examination (SSE) is thought to increase the chances of detecting thinner melanoma lesions and thereby reducing mortality and morbidity from this disease. However, epidemiologic data supporting regular skin cancer surveillance remains equivocal compared to data supporting other cancer detection and prevention practices. Thus, it may be premature to target average risk populations for interventions to improve skin cancer surveillance practices. However, a strong case can be made for focusing prevention and surveillance efforts on subgroups of individuals at increased risk for melanoma. These individuals would benefit from information about the health behavior changes that may reduce their melanoma risk. In the proposed study, we focus on first degree relatives of individuals diagnosed with melanoma who have one additional risk factor (e.g., blonde hair). Research indicates that family members pay little attention to sun protection and to skin cancer surveillance. Guided by the Preventive Health Model and the Theory of Planned Behavior, we have been able to elucidate key attitudinal factors that play a role in UV protection and CMM surveillance practices among family members at increased risk. We have utilized these data to design a tailored print and telephone counseling intervention targeted to family members of individuals with melanoma. The primary aim of the proposed study is to refine our tailored messages and conduct a randomized clinical trial testing a tailored print and phone counseling intervention against the best available public health education materials for skin cancer prevention. We will target family members who are not compliant with TCE and who are minimal performers of SSE and sun protection. 396 family members will complete the study. Outcomes will be evaluated in terms of TCE, SSE and sun protection habits, as well as changes in attitudes and knowledge about CMM