背景:局部黑色素瘤治疗后,患者参加常规预定的诊所,以监测新的原发性或复发性黑色素瘤。以患者为主导的监测(使用患者进行的远程皮肤镜检查进行皮肤自我检查)是一种替代的随访模式,可以取代一些常规的定期就诊。
目的:本研究旨在评估黑色素瘤自我监测(MEL-SELF)试点随机临床试验中患者主导的监测(干预)与常规护理(对照)的参与者中,假设减少常规预约访视的可接受性。
方法:曾在新南威尔士州接受过局部黑色素瘤治疗的患者,参与MEL-SELF试验随机临床试验,被要求在基线和6个月试验后对基于网络的问卷做出回应。我们使用混合方法分析数据。感兴趣的主要结果是假设减少常规计划的黑色素瘤监测访视的可接受性。
结果:在100名随机参与者中,87在基线时回答了问卷,66在6个月时回答了问卷,和79在任一时间点提供了自由文本解释。6个月时,对照组的33%(17/51)和干预组的35%(17/49)表明,假设所有黑色素瘤医生的常规计划就诊减少至少是可以接受的(比例差异-1%,95%CI-20%至17%;P=.89)。与会者建议,减少常规计划访问的先决条件将包括自上次诊断以来已经过了足够的时间而没有新的原发性黑色素瘤或复发。如果病人注意到一些有关的事情,可以在短时间内预约,他们的黑色素瘤医生建议减少他们的诊所就诊频率,患者相信患者主导的监测是一种安全有效的替代方案.参与者认为,如果他们认为新发或复发性黑色素瘤的风险非常高,则减少常规计划的访问是不可接受的。在皮肤自我检查和使用患者主导的监测干预技术方面自我效能低,以及他们偏爱临床医生主导的监测。一些患者说,部分减少到一年一次可能是可以接受的。
结论:如果确保患者主导的监测是安全有效的,一些患者可能会接受减少常规计划的访视。
背景:澳大利亚新西兰临床试验注册ACTRN12616001716459;https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865&isReview=true;ClinicalTrials.govNCT03581188;https://clinicaltrials.gov/ct2/show/NCT03581188。
■RR2-10.1001/jamadermatol.2021.4704。
BACKGROUND: After treatment for a localized melanoma, patients attend routinely scheduled clinics to monitor for new primary or recurrent melanoma. Patient-led surveillance (skin self-examination with patient-performed teledermoscopy) is an alternative model of follow-up that could replace some routinely scheduled visits.
OBJECTIVE: This study aims to assess the acceptability of a hypothetical reduction in routinely scheduled visits among participants of the Melanoma Self Surveillance (MEL-SELF) pilot randomized clinical trial of patient-led surveillance (intervention) versus usual care (control).
METHODS: Patients previously treated for localized melanoma in New South Wales who were participating in the MEL-SELF pilot randomized clinical trial were asked to respond to a web-based questionnaire at baseline and after 6 months on trial. We used mixed methods to analyze the data. The main outcome of interest was the acceptability of a hypothetical reduction in routinely scheduled visits for melanoma surveillance.
RESULTS: Of 100 randomized participants, 87 answered the questionnaire at baseline, 66 answered the questionnaire at 6 months, and 79 provided a free-text explanation at either time point. At 6 months, 33% (17/51) of the control group and 35% (17/49) of the intervention group indicated that a hypothetical reduction in routinely scheduled visits with all melanoma doctors was at least slightly acceptable (difference in proportions -1%, 95% CI -20% to 17%; P=.89). Participants suggested that prerequisites for a reduction in routinely scheduled visits would include that sufficient time had elapsed since the previous diagnosis without a new primary melanoma or recurrence, an unscheduled appointment could be made at short notice if the patient noticed something concerning, their melanoma doctor had suggested reducing their clinic visit frequency, and patients had confidence that patient-led surveillance was a safe and effective alternative. Participants suggested that a reduction in routinely scheduled visits would not be acceptable where they perceived a very high risk of new or recurrent melanoma, low self-efficacy in skin self-examination and in the use of technologies for the patient-led surveillance intervention, and where they had a preference for clinician-led surveillance. Some patients said that a partial reduction to once a year may be acceptable.
CONCLUSIONS: Some patients may be receptive to a reduction in routinely scheduled visits if they are assured that patient-led surveillance is safe and effective.
BACKGROUND: Australian New Zealand Clinical Trials Registry ACTRN12616001716459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865&isReview=true; ClinicalTrials.gov NCT03581188; https://clinicaltrials.gov/ct2/show/NCT03581188.
UNASSIGNED: RR2-10.1001/jamadermatol.2021.4704.