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Clinical skin examination outcomes after a video-based behavioral intervention: analysis from a randomized clinical
Monika Janda1, Philippa Youl2, Rachel Neale3
1School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Importance:
Older men are at risk of dying of melanoma.
Objective:
To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention.
Design, Setting, And Participants:
This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461; overall response rate, 37.1%) and were again interviewed 7 months later (n = 870; 93.5% retention).
Interventions:
Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only.
Main Outcomes And Measures:
Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy.
Results:
Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%]; control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group; P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls; P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis.
Conclusions And Relevance:
A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men.
Trial Registration:
anzctr.org.au Identifier: ACTRN12608000384358.
Insights
A video intervention increased whole-body skin examinations in older men, leading to more skin cancer diagnoses. This approach may improve early detection and outcomes for this high-risk group.
Area of Science:
- Dermatology
- Preventive Medicine
- Behavioral Science
Background:
- Older men face a heightened risk of melanoma mortality.
- Early detection through clinical skin examinations (CSEs) is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the impact of a video-based behavioral intervention on CSE attendance and clinical outcomes in older men.
- To assess if the intervention increases the likelihood of whole-body examinations and subsequent skin cancer detection.
Main Methods:
- A randomized clinical trial involving men aged 50 years and older.
- Participants received either a video intervention promoting skin awareness and self-examination or brochures only.
- Data collected included self-reported CSEs, examination details, and physician-reported outcomes over a 7-month follow-up period.
Main Results:
- While overall CSE attendance was similar between groups, the intervention group showed a significantly higher rate of whole-body CSEs (35.3% vs. 27.2%, P=.01).
- The intervention group had a higher proportion of malignant skin lesions diagnosed (60.0% vs. 40.0%, P=.03), including two melanomas.
- Baseline factors such as attitudes, behaviors, and prior skin cancer history were associated with increased CSE likelihood and diagnosis.
Conclusions:
- A video-based intervention can effectively promote whole-body clinical skin examinations in older men.
- This intervention strategy shows potential for increasing the diagnosis of skin cancers, including melanoma, in this demographic.
- Behavioral interventions targeting older men may enhance skin cancer screening and early detection efforts.
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