Abstract
OBJECTIVES: To describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline.
DESIGN: A longitudinal observational study nested within the intervention arm of the ASICA (Achieving Self-Directed Integrated Cancer Aftercare) randomised controlled trial.
SETTING: Follow-up secondary care in Aberdeen and Cambridge UK.
PARTICIPANTS: n=104 adults (48 men/56 women; mean age 58.83 years, SD 13.47, range 28-85 years; mean Scottish Index of Multiple Deprivation score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial.
INTERVENTIONS: All participants were using the ASICA intervention-a tablet-based intervention designed to support monthly TSSE.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app.
RESULTS: Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent.
CONCLUSIONS: Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03328247).
| Original language | English |
|---|---|
| Article number | e056755 |
| Number of pages | 9 |
| Journal | BMJ Open |
| Volume | 12 |
| Issue number | 8 |
| Early online date | 30 Aug 2022 |
| DOIs | |
| Publication status | Published - 30 Aug 2022 |
Keywords
- Adult
- Child
- Child, Preschool
- Female
- Humans
- Longitudinal Studies
- Male
- Melanoma/diagnosis
- Self-Examination
- Skin Neoplasms/diagnosis
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