Colleagues in skin cancer prevention: the family practitioner, pediatrician, internist, gynecologist, physician assistant and the nurse

Public health engagement: detection of suspicious skin lesions, screening and referral behaviour of UK based chiropractors

BACKGROUND

UK morbidity and mortality rates from skin cancer are increasing despite existing preventative strategies involving education and early detection. Manual therapists are ideally placed to support these goals as they see greater quantities of exposed patient skin more often than most other healthcare professionals. The purpose of this study therefore was to ascertain the ability of manual therapists to detect, screen and refer suspicious skin lesions.

METHOD

A web-based questionnaire and quiz was used in a sample of UK chiropractic student clinicians and registered chiropractors to gather data during 2011 concerning skin screening and referral behaviors for suspicious skin lesions.

RESULTS

A total of 120 questionnaires were included. Eighty one percent of participants agreed that screening for suspicious skin lesions was part of their clinical role, with nearly all (94%) assessing their patients for lesions during examination. Over 90% of the participants reported regularly having the opportunity for skin examination; with nearly all (98%) agreeing they would refer patients with suspicious skin lesions to a medical practitioner. A third of respondents had referred a total of 80 suspicious lesions within the last 12 months with 67% warranting further investigation.

CONCLUSIONS

Nearly all respondents agreed that screening patients for suspicious skin lesions was part of their clinical role, with a significant number already referring patients with lesions.

Preventing skin cancer among a farming population: implementing evidence-based interventions

Agricultural workers are at risk for developing skin cancer due to exposures to ultraviolet radiation. Occupational health nurses implemented a skin cancer screening during an agricultural trade show to facilitate primary and secondary prevention of skin cancer through risk assessment, visual skin examination, counseling, and education. The purpose of this article is to present an evidence-based practice model that describes the demographics of a skin cancer screening population, self-reported risk factors, the occurrence of presumptive diagnoses, and compliance with health-related recommendations. Eighty-eight individuals were screened. Thirty-nine (44%) of all screened participants were referred for further evaluation. Of the 39 referrals, 16 (41%) were recommended for biopsy. One month after the screening, 21 (54%) of the participants had completed or arranged follow-up. Status of the identified lesion was also explored. General comments yielded statements that demonstrated appreciation for the screening, teaching, reminders, and encouragement.

Skin cancer prevention and detection by nurses: attitudes, perceptions, and barriers

BACKGROUND

To examine attitudes and perceptions of nurses with respect to skin cancer prevention and detection; to identify barriers to skin cancer prevention and detection by nurses.

METHODS

Descriptive survey of 457 nurses from the Texas State Board of Nurse Examiners in 1997.

RESULTS

Eighty-nine percent of the nurses reported that skin cancer was a serious problem, and 97% believed that many people were at risk. More than 89% stated that skin cancer prevention/detection would benefit patients, and 94% believed that such skills would benefit nurses. Eighty-four percent reported that it was in their scope of practice to teach skin cancer prevention to patients, and 61% stated that it was in their scope of practice to detect skin cancer in patients. Barriers to skin cancer prevention and detection included lack of national guidelines (69%), low priority among doctors (63%), and the belief that patients should take full responsibility for prevention (50%). Barriers to continuing education for skin cancer screening included lack of money (43%), not knowing how to obtain education (41%), time away from work (36%), and time away from home (26%).

CONCLUSIONS

These findings may suggest that nurses can play a role in skin cancer prevention and detection.

Use of nonphysician health care providers for skin cancer screening in the primary care setting

BACKGROUND

Nonphysician health care providers are in an optimal position to provide cancer prevention and screening services.

METHODS

We conducted a survey of primary care physicians to determine physician use and amenability to use of nonphysician health care providers to perform skin cancer screening in comparison with other cancer screening examinations.

RESULTS

A total of 1,363 eligible physicians completed the survey. Of these, 631 physicians (46%) reported a nurse practitioner or physician assistant performing at least one type of cancer screening examination on their patients. Twenty-nine and 22% of all physicians reported nurse practitioners or physician assistants performing skin cancer screening, respectively. Family physicians were more likely to use nurse practitioners and physician assistants to perform these cancer screening examinations than internists (chi(2) test, P = 0.001 for each examination). Skin examinations were performed less frequently by nurse practitioners and physician assistants than all other cancer screening examinations. A total of 73-79% of family physicians and 60-70% of internists were amenable to having a nonphysician health care provider perform one or more of these examinations.

CONCLUSIONS

Primary care physicians are currently utilizing nonphysician health care providers to perform cancer screening examinations and the majority of those surveyed are amenable to the use of these providers for such examinations. This suggests that one possible strategy for increasing skin cancer screening is through an expanded role of nonphysician health care providers.

Using nurse practitioners for skin cancer screening: a pilot study

BACKGROUND

Skin cancer screening has the potential to detect early precancerous lesions and may ultimately be important in reducing melanoma mortality. The purpose of this study was to evaluate the ability of trained nurse practitioners to accurately identify suspicious lesions in a clinical setting.

METHODS

We identified five nurse practitioners who had no previous experience in evaluating skin lesions. Each nurse practitioner participated in a training program for skin cancer detection consisting of a workshop, clinical apprenticeship, and didactic lectures.

RESULTS

Evaluation of nurse practitioner competency involved three assessments. First, the nurse practitioner's ability to distinguish benign and malignant lesions was assessed using clinical color slides. The sensitivity of all five nurse practitioners to refer benign and malignant lesions for dermatologic follow-up based on the slides was 100%, whereas the specificity ranged from 53% to 100%. Second, each nurse practitioner evaluated approximately 25 different patients along with a single dermatologist. The nurse practitioner's ability to correctly refer patients with suspicious lesions for dermatologic follow-up was determined based on the dermatologist's assessment of need for referral. Results suggested a referral sensitivity and specificity ranging from 67% to 100% and 62% to 100%, respectively. In the final clinical assessment, 30 patients were independently examined by two dermatologists and four nurse practitioners. Using the consensus clinical diagnosis of the dermatologists as the gold standard, the nurse practitioner's sensitivity for detecting significant skin cancer lesions ranged from 50% to 100% and the detection specificity was 99% to 100%.

CONCLUSIONS

These preliminary results have important implications for skin cancer screening efforts and suggest that nurse practitioners can be trained to accurately identify and triage suspicious lesions.

Skin cancer screening and prevention in the primary care setting: national ambulatory medical care survey 1997

OBJECTIVE

To describe skin cancer prevention and screening activities in the primary care setting and to compare these findings to other cancer screening and prevention activities.

DESIGN

Descriptive study.

SETTING/PATIENTS

National Ambulatory Medical Care Survey 1997 data on office-based physician visits to family practitioners and internists.

MEASUREMENTS AND MAIN RESULTS

Data were obtained on 784 primary care visits to 109 family practitioners and 61 internists. We observed that the frequency of skin cancer prevention and screening activities in the primary care setting was much lower than other cancer screening and prevention activities. Skin examination was reported at only 15.8% of all visits (17.4% for family practitioners vs 13.6% for internists, P >.1). For other cancer screening, the frequencies were as follows: breast examination, 30.3%; Papanicolaou test, 25.3%; pelvic examination, 27.6%; and rectal examination, 17.9%. Skin cancer prevention in the form of education and counseling was reported at 2.3% of these visits (2.9% for family practitioners vs 1.5% for internists, P >.1), while education on breast self-examination, diet and nutrition, tobacco use, and exercise was 13.0%, 25.3%, 5.7%, and 17.9%, respectively.

CONCLUSIONS

The results of this study indicate that the proportion of primary care visits in which skin cancer screening and prevention occurs is low. Strategies to increase skin cancer prevention and screening by family practitioners and internists need to be considered.