Contacting bereaved relatives: the views and practices of palliative care and oncology health care professionals

There are few data on the interactions of health care professionals with bereaved relatives. The objective of this study was to explore the current practice of health care professionals in oncology and palliative care in contacting bereaved relatives, and to elicit their views regarding the purpose, the optimal means, the format, timing, and content of these contacts. We conducted 28 in-depth, semi-structured interviews with health care professionals in Australia working in palliative care and oncology. The interviews were audiotaped and transcribed. Further interviews were conducted until no additional themes were raised. The narratives were analyzed using qualitative methodology. Most participants were in favor of contacting bereaved relatives after the death of a patient they had cared for. Some barriers to implementing these contacts were identified, including time constraints, institutional factors, and personal barriers. Contacts ranged from a personal phone call to a standardized letter. Timing of contacts varied from immediately after the death of the patient to several weeks later. Participants used words and phrases in these contacts that ranged from personal and individualized messages to standard phrases. Health care professionals emphasized the importance of contacting bereaved relatives after the death of a patient for whom they had cared. The format and content of current contacts vary widely, and there does not seem to be a gold standard approach. This area has been relatively unexplored and lacks adequate models for health care professionals. This study provides some insight into current practice and hopes to facilitate further discussion of this topic.

Professional burnout among Spanish medical oncologists

INTRODUCTION

Studies on physician burnout in Spain show a significant presence of the syndrome among our professionals. Some studies highlight the speciality of medical oncology as one of the most affected. The objective of this study was to evaluate the incidence of burnout syndrome among the group of medical oncologists affiliated to the Spanish Society of Medical Oncology (SEOM), as well as to assess the weight of sociodemographic variables, background and consequences involved in the process.

MATERIALS AND METHODS

An anonymous protocol was posted to medical oncologist members of the SEOM (n=795). This protocol comprised a scale of sociodemographic variables and three scales of the Medical Professional Burnout Questionnaire. In response we received 200 complete protocols and statistical analyses were conducted with the programme SPSS, version 14.0.

RESULTS

The sample showed high burnout levels in the areas of exhaustion and loss of expectations, with perception of time pressure to conduct work and social deterioration perceived in the profession as the two background elements with the greatest weight to explain the syndrome. The health consequences (physical and emotional) for the phy - sician are clear. Initial results show that conducting research and lecturing tasks could be a protective factor against developing the syndrome.

CONCLUSIONS

The results suggest the importance of developing prevention and intervention lines for medical oncology burnout. In this sense, issues such as work time management and motivational aspects related to research tasks could be worth considering.

[Bibliometry of cancer in Portugal: 1997 to 2006]

INTRODUCTION

the scientific production of Portuguese institutions in the specific field Oncology during a 10 year period (1997-2006) was evaluated. The contribution of national authors to the international scientific production was verified. This enabled to assess and quantify the importance of authors, departments, institutions and scientific investigations.

MATERIAL AND METHODS

Using version 2006 of Web of Science, section Science Citation Index, a database of literature references which enables analysis of citations, and also the Journal Citation Reports (tools produced by ISI Thomson Scientific), a quantitative and qualitative analysis of the Portuguese scientific production on cancer between 1997 to 2006 was performed.

RESULTS

during the studied period, 1.384 articles were published in scientific journals with given impact factor, which obtained a total of 16.484 citations, corresponding to a mean of 11.91 citations per article. Between 1997 and 2006 an increase of 214% was noticed in the national scientific production in the selected field. Ten authors represent 46% of the produced documents. The majority of published articles were performed by Universities, being Oporto University the one with highest contribution. Co-authorship is the rule in the production of articles and Portugal is no exception. Articles with international collaboration where those which obtained the highest citation rate. The Portuguese contribution to the international scientific production in the field of Oncology in the studied period was of 0.21%.

CONCLUSIONS

Bibliometric analysis is a reliable tool to evaluate the development and quality of scientific production. A growing visibility of investigation in this area was observed. This conclusion is based on the increase in the number of articles published in international journals of recognized reputation. National authors publish few articles, but they select high standard journals.

Impact of patient age and comorbidity on surgeon versus oncologist preferences for adjuvant chemotherapy for stage III colon cancer

BACKGROUND

To study surgeons' versus oncologists' preferences for adjuvant chemotherapy for elderly patients with stage III colon cancer, as population studies indicate that such patients are less likely to receive treatment.

STUDY DESIGN

A vignette-based survey was mailed to a nationally representative sample of 1,000 general surgeons and 1,000 oncologists in the United States. Patient age, comorbidity level, and preference were varied across eight vignettes. Physician preference for referral (surgeons) or treatment (oncologists) was measured using a 7-point Likert scale. Mixed-effects linear regression was used to evaluate the results.

RESULTS

One thousand twenty-nine surveys were returned (response rate of 54%). Among surgeons, increasing age and more severe comorbidity resulted in lower likelihood of referral to oncologist: mean difference in preference scores for vignettes describing a 61-year-old versus an 83-year-old patient (adjusted for comorbidity) was 0.77 (p < 0.0001); mean difference in scores between vignettes describing a patient with none versus severe comorbidity, adjusted for age, was 1.94 (p < 0.0001). Among oncologists, patient age and comorbidity interacted significantly (p < 0.0001) to affect oncologists' preferences: both increasing age and more severe comorbidity resulted in decreased preference for recommending adjuvant chemotherapy, but oncologists were more heavily influenced by comorbidity at younger patient age. Patient preference against therapy also affected physicians' recommendations (p < 0.0001), but the magnitude of effect was small relative to age and comorbidity.

CONCLUSION

Patient age and comorbidity level influence both types of physicians' preferences about adjuvant chemotherapy for colon cancer and might explain some of the patterns of care seen for this disease in population-based studies.

Prescription pattern of aromatase inhibitors for the adjuvant therapy of breast cancer in Germany - results of the second survey among gynaecologists and medical oncologists

INTRODUCTION

In sequence to our first survey in 2004 on antihormonal therapy with aromatase inhibitors (AIs), we conducted a second survey on the prescription practice in 2005.

MATERIAL AND METHODS

We distributed the anonymous questionnaires amongst the participants of the 2005 congresses of the German Society of Senology and German Society of Haematology and Oncology.

RESULTS

The surveys were mostly completed by gynaecologists (46%) and medical oncologists (46%). According to the responses given, over 31,000 breast cancer patients were treated in these institutions in 2004, over 18,000 of whom received AIs. 37/30% of doctors prescribed AIs for national/private health insurance patients depending on the known risks of tamoxifen treatment (> 50% of cases). Whilst only 6/10% of doctors prescribed AIs for more than 50% of patients with either national/private health insurance in 2004, this figure reached 49% in 2005, independent of the type of medical insurance. Assuming unrestricted approval, 68/65% of doctors would treat over 50% of their patients with an AI.

CONCLUSION

The rate of treatment with AIs has increased dramatically. The previous gold standard, tamoxifen, was by and large replaced by AIs in 2004/2005. We may assume that almost all receptor- positive breast cancer patients will receive an AI in the course of their adjuvant therapy in the very near future.

[Phenotype and genotype characterization of Candida albicans strains isolated from patients hospitalized at the Children's Memorial Health Institute]

Phenotype and genotype analysis was prepared from Candida strains causing colonization and fungal infections in children hospitalized at The Children's Memorial Health Institute intensive care unit and oncology unit. We totally analyzed 117 C. albicans strains cultured from different clinical specimens received from 51 patients--oncology unit (26) and intensive care unit (25). Enzymatic activity was assessed by API ZYM bioMerieux. Strains were biotyped according to Williamson, Kurnatowska and Kurnatowski classification. Candida albicans isolates were RAPD typed. C. albicans strains causing colonization and fungal infections on those units released such enzymes like esterase lipasis, waline arylamidasis and phosphohydrolasis. The most frequent biotypes in group of patients oncological unit with fungal infections were biotype E (64.7%) and biotype C (26.6%) while in group of patients with colonized mucosa dominated biotypes: E (28.6%) and A (28.5%). Comparing with intensive care unit group patients, the most frequent biotype isolated among patients with fungal infection symptoms was biotype E (71.7%), while in mucosa colonization group C (35.5%) occurred as a dominating biotype. This study demonstrated clonal character of fungal infections among patients hospitalized in two units and considerable polymorphism among yeast strains: 23 pattern stripes in oncology unit and 28 pattern stripes in intensive care unit. What is more, yeast biotype determination allows showing frequent occurrence of virulence character of isolates received from infected patients in comparison with those received from colonized patients.

Discrepancies in performance status scores as determined by cancer patients and oncologists: are they influenced by depression?

OBJECTIVE

In previous research studies, performance status as determined by cancer patients themselves frequently did not agree with that determined by their oncologists. However, only a few studies have evaluated the reasons for this discrepancy.

METHODS

One hundred eleven cancer patients attending the Comprehensive Cancer Center of Seoul National University Hospital were asked to complete a questionnaire that included questions on sociodemographic and medical status, Eastern Cooperative Oncology Group (ECOG) performance status score and the Hospital Anxiety and Depression Scale (HADS). Medical oncology records were reviewed to obtain information and oncologist-assessed ECOG performance status scores.

RESULTS

Patients and oncologists agreed in 59 cases (53.2%; weighted kappa=0.17). There were no statistically significant gender-, cancer-type- or cancer-stage-related differences in agreement rates. Hierarchical logistic regression analyses showed that HADS depression subscale was the only variable that significantly contributed to patient-assessed performance status scores (beta=0.50, P=.0005), whereas cancer stage was the only variable that significantly contributed to oncologist-assessed performance status scores (beta=0.34, P=.0004). The mean of HADS depression subscale and the depression rates were highest in patients who rated themselves as most impaired on ECOG performance.

CONCLUSIONS

Depression was found to be significantly associated with patients who rated their performance status as more impaired than with the oncologist-assessed score.

[Use of complementary medicine by cancer patients in a French oncology department]

The aims of this study was to estimate and describe the reasons of use of complementary medicine in patients with a cancer treated in a French oncology department. An anonymous questionnaire was proposed to patients during treatment or follow-up in an oncology department. It was a descriptive study over 207 questionnaires. Over 195 analysable questionnaires, 34% of patients were using complementary medicine. Homeopathy (42%), plants (27%) and vitamins (18%) were the main substances used. Acupuncture (22%) and massages (15%) were the most significant techniques. No specific profile of user was observed. The main reason of using complementary medicine was not curing cancer but reducing side effects of the conventional treatment (66%). More than a half of the users of complementary medicine were not revealing their habits to their oncologist because the question was not raised in consultation. One third of cancer patients are using complementary medicine during the treatment of their disease. Complementary medicine must benefit, as well as conventional medicine, of scientific studies. The purpose of these studies should be evaluating potential benefits, toxicity and interactions with the conventional treatment in order the oncologist could warned the users. This warning could improve the confidence relationship between the oncologist and his patient.

Frequency, Type, and Monetary Value of Financial Conflicts of Interest in Cancer Clinical Research

Purpose

Using data from American Society of Clinical Oncology (ASCO) Annual Meetings, we determined the frequency, type, and monetary value of researchers' financial interests.

Methods

Financial disclosures for the 2004 (3,529 abstracts and 25,416 authors) and 2005 (3,556 abstracts and 26,181 authors) ASCO Annual Meetings were categorized into four groups: no author with a financial interest, research funding only, employment and leadership positions only, or at least one author with a personal financial interest. Interests were stratified by monetary value and other factors.

Results

In 2004 and 2005, 23% of abstracts had one or more authors with a personal financial interest. More than 75% of all personal financial interests were valued at less than $10,000. More than 90% of financial interests of more than $100,000 were employment related. Fewer than 3.5% of authors with personal financial interests had interests valued at more than $100,000. Overall, 6.3% (2004) and 2.9% (2005) of abstracts only had research funding, whereas 7.3% (2004) and 6.9% (2005) had only commercial employment. In 2005, 60% of plenary sessions compared with 23.1% in general poster sessions and 17.3% for publish-only abstracts reported financial ties. Personal financial interests were more common among US authors compared with non-US authors (9.2% v 4.2%).

Conclusion

About one fourth of abstracts at ASCO Annual Meetings have an author with a personal financial interest. Most personal financial interests are valued at less than $10,000 per year, whereas a majority valued at more than $100,000 are related to employees of commercial entities.

Patients'and doctors' views of using the schedule for individual quality of life in clinical practice

This study explored patients' and oncologists' perceptions of using a computer-administered, individualized quality-of-life (QOL) instrument to support an oncologic consultation. Twenty patients with gastrointestinal cancer (50% female; mean age 60 years) at two hospitals in Sweden completed the Schedule for the Evaluation of Individual Quality of Life-Direct Weight (SEIQoL-DW) and the Disease-Related (DR) SEIQoL-DW and brought the results to the consultation. Afterwards, interviews were conducted with all patients and six of eight doctors. All interviews were audiotaped, transcribed, and analyzed using an interpretivist approach. Most patients and doctors believed that the instrument would facilitate detection of patients' areas of concern and would support monitoring of patients' QOL. This tool may empower the patient, give the doctor a broader picture of the patient, and influence clinical decision-making. The SEIQoL-DW may be a systematic method of stimulating patient-centered care. It apparently encourages patients to reflect upon their own situation and allows them to be seen as whole persons. However, further quantitative evaluation of the intervention's outcomes is required.

A study of oncology fellows' training in end-of-life care

Caring for the dying is a core competency for oncologists, yet the quality of oncology fellowship training in end-of-life (EOL) care has not been assessed. A convenience sample of physicians attending the 2004 annual meeting of the American Society of Clinical Oncology responded to a 112-item questionnaire that assessed fellows' knowledge and education about EOL care. Of the 120 respondents, 107 (89%) rated caring for dying patients as"quite" or "very important. "Forty-two percent of the fellows rated the overall quality of teaching EOL care in their fellowship as "very good" or "excellent," whereas 23% gave such ratings to EOL teaching in fellowship (P < or = 0.001). Fellows viewed attending oncologists as having more expertise in dealing with acute complications of cancer (eg, managing spinal cord compression, 78%) than in delivering EOL care (eg, managing pain, 54%; P < 0.001). Fellows also were more likely to have received observation and feedback on bone marrow biopsies than on EOL discussions. Knowledge about key EOL care topics was poor; only 31% correctly performed an opioid conversion. Oncology fellows described deficiencies in training on EOL issues;they may benefit from improved education on EOL topics.

Impact of computerised chemotherapy prescriptions on the prevention of medication errors

OBJECTIVES

The authors sought to evaluate the impact of computerised chemotherapy prescription on the reduction of medication errors. The purpose of this study was to assess the incidence of errors present in electronic versus manual prescription.

MATERIAL AND METHODS

The data gathered from computerised chemotherapy prescription sheets were submitted to a prospective analysis as cases of the intervention groups. The control group was comprised of the handwritten chemotherapy prescription sheets. Chemotherapy prescriptions for consecutive oncology patients were analysed by 2 independent examiners, who investigated errors of omission, commission, interpretation of dates, abbreviations and illegible handwriting. The proportion of treatment prescriptions containing one or more errors and the median of errors were calculated in order in both groups.

RESULTS

At least one error was detected in 100% of the manual prescriptions and in 13% of computerised prescriptions (p < 0.001). The median of errors per computerised prescription was 0 (range: 0- 1), whereas in manual prescriptions the median was 5 (range: 1-12) (p < 0.001). Errors of omission were predominant in manual prescriptions. Errors of commission were limited to 1 case of unjustified cytostatic agent infra-dosage in a computerised prescription. This error was present in 3 cases in handwritten prescriptions and, in addition, 1 case of premedication drug substitution was detected. Errors of interpretation of the date, use of abbreviations and illegible handwriting were frequent among manual prescriptions and were absent from computerised prescriptions.

CONCLUSIONS

Electronic chemotherapy prescription is a powerful tool. In this study it has been shown to decrease chemotherapy-related medication errors and ensure that safe chemotherapy practices were followed.

Surveillance testing among survivors of early-stage breast cancer

PURPOSE

Guidelines recommend against routine surveillance testing for women who have had breast cancer. We described follow-up care for breast cancer survivors, examined how surveillance testing varies by the types of physicians seen, and assessed changes in testing rates over time.

METHODS

Using Surveillance, Epidemiology, and End Results-Medicare data, we studied a population-based cohort of 44,511 women age > or = 65 years diagnosed with stage I/II breast cancer during 1992 to 1999 and observed through 2001. We measured bone scans, tumor antigen tests, chest x-rays, and other chest/abdominal imaging during 3 consecutive surveillance years. We described physicians seen in follow-up and used repeated-measures logistic regression to assess the relationship with testing and to assess testing trends over time.

RESULTS

Nearly half of breast cancer survivors saw a medical oncologist in surveillance year 1, but only 27% saw a medical oncologist annually for 3 years. In adjusted analyses, women seeing medical oncologists had more bone scans, tumor antigen testing, chest x-rays, and chest/abdominal imaging than other women (all P < .001). Nevertheless, rates of testing decreased over time (all P < .001). Rates of tumor antigen testing and chest x-rays decreased faster and chest/abdominal imaging increased slower among women seeing medical oncologists than among other women (all P < .05).

CONCLUSION

Non-recommended testing for early-stage breast cancer patients has decreased over time. Although most breast cancer survivors did not see oncologists annually, those who did had substantially higher rates of testing than others; whether such testing in this low-risk population was due to more symptoms or excessive surveillance is an important question for additional study.

Detection of clonal IGH gene rearrangements: summary of molecular oncology surveys of the College of American Pathologists

CONTEXT

The diagnosis of B-cell lymphoid malignancy can frequently be substantiated by detecting clonal immunoglobulin heavy chain (IGH) gene rearrangements, which is typically done by polymerase chain reaction (PCR) amplification and/or Southern blot analysis.

OBJECTIVE

To characterize current laboratory practice for the assessment of IGH rearrangements and to identify opportunities for improvement.

DESIGN

The data from the Molecular Oncology Proficiency Survey distributed to participating laboratories by the Molecular Pathology Committee of the College of American Pathologists from 1998 through 2003 were analyzed.

RESULTS

Thirty-nine proficiency survey specimens (29 positive and 10 negative for clonal IGH rearrangements) were distributed. For Southern blot analysis, 944 results were reported, with a successful response rate of 95%. For PCR detection, 2349 results were reported, with a successful response rate of 72%. A higher rate of successful responses by PCR was achieved using framework 3 primers in combination with other frameworks (82%) compared with framework 3 primers only (76%) and when fresh/frozen (72%) compared with paraffin-embedded (65%) tissues were analyzed.

CONCLUSIONS

The performance of the participating laboratories was very good, by both Southern blot and PCR analysis. As expected, Southern blot analysis consistently detects a higher proportion of IGH rearrangements than PCR analysis. Further improvement and standardization of the IGH PCR assay is important if it is to replace Southern blot analysis as the standard method. Participation in this survey is a valuable tool for assessing laboratory performance and it directs our attention to areas where we may improve laboratory practice.

Establishing of the first private autologous cord blood bank in Georgia at the German-Georgian Specialized Oncological Clinic

German-Georgian Specialized Oncological Clinic is a private clinic located in Tbilisi, Georgia. Close collaboration with German clinics and research laboratories has enabled the clinic to study cord blood hematopoietic stem cells. These studies created a scientific basis for establishing a cord blood bank. A municipal grant from the city of Tbilisi allowed the clinic to establish a program for the support of families with oncohematological patients. The program collected and stored cord blood for families with oncohematological histories. This grant has also enabled the establishment of an autologous cord blood bank and created opportunity for cord blood banking in Georgia. Work on a national legal basis of cord blood banking together with the Ministry of Labor, Health and Social Affairs of Georgia is another important activity of the German-Georgian Oncological Clinic.

Adjuvant treatment recommendations in older women with breast cancer—A survey of oncologists

OBJECTIVE

Previous studies demonstrate differing treatment patterns between older and younger patients with breast cancer. To explore the reasons for these disparities we conducted a survey of 28 oncologists specializing in breast cancer.

DESIGN AND METHODS

Twenty-eight medical oncologists from Memorial Sloan-Kettering Cancer Center and the University of California Los Angeles who specialize in the treatment of breast cancer were asked to provide adjuvant treatment recommendations in hypothetical scenarios featuring older patients with high-risk breast cancer. For each of these hypothetical patients, the patient's age was varied over four possible values (70, 75, 80, or 85 years of age) and health and functional status varied across three possible states (perfect health, average health, or major health problems). Survey data were compiled and analyzed to determine the impact of theoretical patient age, baseline health, and functional status on their treatment recommendations.

RESULTS

The proportion of oncologists who recommended adjuvant chemotherapy decreased as the patient's age increased or as the patient's functional status and health status decreased. For 96% of physicians (95% CI, 82-100%), patient age influenced chemotherapy recommendations, controlling for health/functional status; the same proportion of respondents were influenced by health/functional status, controlling for patient age. There was increased variability in treatment recommendations as the patient's age increased or functional status and health status decreased.

CONCLUSION

Among these medical oncologists who primarily treat breast cancer adjuvant treatment recommendations vary based on patient age, health, and functional status. Future studies are needed to correlate age, health, and functional status with the risks and benefits of adjuvant therapy so that consensus guidelines can be formed. A more comprehensive baseline assessment of the older patient, such as can be derived from a comprehensive geriatric assessment may be useful in this regard.

The impact of the Calman-Hine report: analysis of breast and colorectal cancer surgical workloads and the degree of surgical site specialization in the Yorkshire region of the UK, 1990?2000

The 1995 Calman-Hine report set out the first overall cancer policy for England and Wales, with the aim of improving the quality of care offered to cancer patients. One of its key recommendations was to concentrate cancer care in the hands of site-specialist doctors. This retrospective population-based study aimed to determine whether this recommendation has been implemented across the Yorkshire region of the UK (population 3.6 million) for breast and colorectal cancer surgery. Information on all breast and colorectal cancer patients diagnosed between 1990 and 2000 within the former Yorkshire Regional Health Authority of the UK was obtained from the Northern and Yorkshire Cancer Registry and Information Service. The annual median workloads of each surgeon operating on these patients, in terms of breast and/or colorectal cancer, were calculated. Each surgeon was categorized as either specialist or non-specialist based on his or her self-stated interests or workload. The proportion of breast and colorectal patients in each Trust and in each year receiving surgery from a site specialist was calculated to determine the extent of surgical site specialization. The distribution of surgeons' workloads in breast and colorectal cancer surgery was also examined across three time periods; 1990-93, 1994-97 and 1998-2000. There has been a major shift towards surgical site specialization in breast and colorectal cancer care across Yorkshire. The effect was more marked in breast cancer than in colorectal cancer. The degree of surgical site specialization varied considerably across hospital Trusts. In both cancer sites, the move towards surgical site specialization began prior to the publication of the Calman-Hine report.

Where do teenagers and young adults receive treatment for cancer?

BACKGROUND

Little is known about where teenagers and young adults receive their first cancer treatment.

METHOD

We extracted data on 2260 residents of southeast England diagnosed with a malignant neoplasm aged 10-24 between 1998 and 2002 from the Thames Cancer Registry database. We identified 11 cancer network areas of residence, and the hospital and network where each patient received their first chemotherapy treatment. We classified hospitals as those including paediatric oncology centres, cancer centres with a teenage cancer unit or adult cancer centres or units. We examined how many patients in each of the age groups 10-14, 15-19 and 20-24 travelled outside their network of residence for chemotherapy.

RESULTS

Overall 45% (1018) received chemotherapy. Three networks had paediatric oncology centres, and one also had a teenage cancer unit. Most 10-14-year-olds were referred from their network of residence to networks with these services. However, there was an increasing tendency for patients aged 15-19 and 20-24 to be treated within their network of residence and to be referred less commonly.

CONCLUSIONS

Many young people with cancer are not referred to services providing care tailored to the needs of their age group. The absence of any pattern to referral, despite the presence of a teenage cancer unit in the area, suggests a lack of coordinated referral practice within and between cancer networks.

Does Knowledge Influence Melanoma-Prone Behavior? Awareness, Exposure, and Sun Protection Among Five Social Groups

PURPOSE/OBJECTIVES

To examine melanoma-related knowledge, sun exposure, and sun protection to determine whether increased awareness is associated with a reduction in risk.

DESIGN

Quantitative/empiricist study conducted by purpose- designed mailed questionnaire.

PARTICIPANTS

Consultant oncologists at one teaching hospital in London, England; specialist registrars (oncologists in training) contacted through a London-based educational group; oncology-trained nursing staff from oncology departments at two London teaching hospitals; medical students; general (nononcology) nurses; and members of the lay public from one London teaching hospital.

SETTING

Two teaching hospitals in London, both registered cancer centers that possess specialist departments of oncology and are staffed by clinical and medical oncologists.

METHODS

Anonymous, self-completion, mailed questionnaire. RESEARCH VARIABLES: Sun exposure; use of sun protection and avoidance; knowledge of the biologic effects of sun exposure, moles, and malignant melanoma; melanoma-prone behavior.

FINDINGS

No significant differences were found in sun exposure or melanoma-prone behavior across the five groups studied. No correlation existed between knowledge and melanoma-prone behavior. Differences in knowledge and protection scores were demonstrated across all groups and were statistically significant, but they did not translate into changes in exposure or behavior scores.

CONCLUSIONS

Public health policy that seeks to reduce the incidence of melanoma is based on the false premise that increasing awareness of melanoma risk will reduce melanoma-prone behavior. Increasing awareness of the risks of sun exposure may improve the use of sun protection, but it does not reduce melanoma-prone behavior, even among specialist healthcare professionals.

IMPLICATIONS FOR NURSING

This study provides a new epidemiologic tool for nurses working in the specialty.