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Harkemanne E, Duyver C, Leconte S, Sawadogo K, Baeck M, Tromme I. Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1928-1941. [PMID: 34704171 PMCID: PMC8547729 DOI: 10.1007/s13187-021-02063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Corentin Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Sophie Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Fee JA, McGrady FP, Hart ND. Dermoscopy use in primary care: a qualitative study with general practitioners. BMC PRIMARY CARE 2022; 23:47. [PMID: 35291937 PMCID: PMC8925058 DOI: 10.1186/s12875-022-01653-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
Background Skin assessments constitute a significant proportion of consultations with family physicians (commonly called general practitioners or GPs in the UK), and referrals to hospital dermatology departments have risen significantly in recent years. Research has shown that dermoscopy use may help GPs to assess and triage skin lesions, including suspected skin cancers, more accurately. However, dermoscopy is used by a small minority of GPs in the UK. Previous questionnaire studies have aimed to establish in a limited way some perceptions of dermoscopy among GPs: this study aimed to explore more deeply the factors influencing the use of dermoscopy among GPs. Methods This was a qualitative interview study set in UK general practice. A purposive sample was taken of GPs who were established dermoscopy users, GPs who had recently adopted dermoscopy, and those who did not use dermoscopy. A total of twelve semi-structured interviews were conducted. Audio-recordings were transcribed verbatim and analysed using a thematic analysis (Braun and Clarke). Results GPs’ capability to use dermoscopy necessitated receiving adequate training, while previous dermatology experience and support from colleagues were also considered factors that enabled dermoscopy use. The impact of dermoscopy on patient consultations about skin complaints was generally considered to be positive, as was having an ‘in-house’ dermoscopy user within a GP practice to refer patients to. However, training in dermoscopy was not considered a priority for many GPs either due to other more pressing concerns within their practices or the perceived complexity of dermoscopy, alongside barriers such as equipment costs. Significant ethical concerns with posting patient photographs online for training and teaching purposes were also highlighted. Conclusions Both GPs who use dermoscopy, and those who do not, consider it to have an important role in improving skin assessments within primary care. However the need for adequate training in dermoscopy and dermatology more generally was highlighted as a key barrier to its wider use. The development of competency standards for the use of dermoscopy could allow the adequacy of training to be assessed and developed.
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Gimenez L, Druel V, Bonnet A, Delpierre C, Grosclaude P, Rouge-Bugat ME. Experimental system of care coordination for the home return of patients with metastatic cancer: a survey of general practitioners. BMC PRIMARY CARE 2022; 23:283. [PMID: 36396990 PMCID: PMC9673376 DOI: 10.1186/s12875-022-01891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To promote improved coordination between general practice and hospital, the French clinical trial CREDO ("Concertation de REtour à DOmicile") is testing an innovative experimental consultation for patients with metastatic cancer who are returning home. This consultation involves the patient, the patient's referring GP (GPref) and a GP with specific skills in oncology (GPonc) in a specialized care center. The objective of our study is to explore the satisfaction of GPsref about this consultation, in the phase of interaction between GPonc and GPref. METHODS This observational, cross-sectional, multicenter study explored the satisfaction of GPsref who had participated in this type of consultation, via a telephone survey. RESULTS One Hundred GPsref responded to the questionnaire between April and September 2019 (overall response rate: 55%). 84.5% were satisfied with the consultation, and the majority were satisfied with its methods. Half of the GPsref learned new information during the consultation, three-quarters noted an impact on their practice, and 94.4% thought that this type of coordination between the GPref and the oncology specialist could improve general practice - hospital coordination. CONCLUSIONS For GPs, the CREDO consultation seems to be practical and effective in improving the coordination between general medicine and hospital. GPs would benefit from such coordination for all patients with cancer, several times during follow-up and at each occurrence of a medically significant event.
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Affiliation(s)
- Laëtitia Gimenez
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France.
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France.
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, 1 avenue Louis Blériot -, 31500, Toulouse, France.
| | - Vladimir Druel
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
| | - Anastasia Bonnet
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
| | - Cyrille Delpierre
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
| | - Pascale Grosclaude
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole, 1, avenue Irène Joliot-Curie -, 31059, Toulouse Cedex 9, France
| | - Marie-Eve Rouge-Bugat
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, 1 avenue Louis Blériot -, 31500, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole, 1, avenue Irène Joliot-Curie -, 31059, Toulouse Cedex 9, France
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Harkemanne E, Goublomme N, Sawadogo K, Tromme I. Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:898-904. [PMID: 33073347 DOI: 10.1007/s13187-020-01897-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
To improve early melanoma detection, educational programs have been developed for general practitioners (GPs). This study aimed to determine whether the adjunct of teaching basic knowledge of pigmented skin lesions (PSL) to the training in melanoma diagnosis improves the GPs' diagnostic accuracy of melanoma. An interventional prospective study was conducted over a 3-month period where GPs attended a 2-h training course. The 1st session taught clinical melanoma recognition and the 2nd session instructed basic knowledge of PSL. Prior to training, after the 1st, and after the 2nd session, GPs were asked to select the malignant or benign nature of 15 clinical images associated to their clinical history. In total, 56 GPs participated in this study. The number of GPs identifying correctly ≥ 50% of the melanomas increased the most after the 1st session from 15 (26.8%; CI = (15.2; 38.4)) to 44 (78.6%; CI = (67.8; 89.3)) GPs (P < 0.001). The number of GPs correctly identifying ≥ 50% of the benign PSL only increased after completing the entire training, going from 10 (17.9%; CI = [(7.8; 27.9)) GPs to 50 (89.3%; CI = (81.2; 97.4)) GPs (P < 0.001). In this study, GPs identified benign PSL most accurately after the 2nd session. This suggested that teaching GPs the basics of PSL would especially improve their diagnostic accuracy for benign PSL, which could reduce unnecessary referrals to dermatologists. Teaching basic knowledge of PSL in addition to melanoma recognition seemed to enable GPs to triage skin lesions more effectively than when they were only trained to recognize melanoma.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Noémie Goublomme
- General Practice in Centre Médical Chrysalide, Pironchamps, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Harkemanne E, Duyver C, Leconte S, Bugli C, Thomas L, Baeck M, Tromme I. Melanoma Diagnostic Practices of French-Speaking Belgian General Practitioners and the Prospective Study of Their Pigmented Skin Lesion Diagnostic Accuracy and Management. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1316-1324. [PMID: 32448923 DOI: 10.1007/s13187-020-01770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
General practitioners (GPs) are among the main actors involved in early melanoma diagnosis. However, melanoma diagnostic accuracy and management are reported to be insufficient among GPs in Europe. The primary aim of this observational prospective study was to shed light on melanoma diagnostic practices among French-speaking Belgian GPs. The second aim was to specifically analyse these GPs' pigmented skin lesion diagnostic accuracy and management. GPs from the five French-speaking districts of Belgium were asked to complete a questionnaire, before taking part in a melanoma diagnostic training session. First, we assessed the GPs' current melanoma diagnostic practices. Then, their pigmented skin lesion diagnostic accuracy and management were evaluated, through basic theoretical questions and clinical images. These results were subsequently analysed, according to the GPs' sociodemographic characteristics and medical practice type. In total, 89 GPs completed the questionnaire. Almost half of the GPs (43%; CI = [33;54]) were confronted with a suspicious skin lesion as the main reason for consultation once every 3 months, while 33% (CI = [24;43]) were consulted for a suspicious lesion as a secondary reason once a month. Prior to training, one-third of the GPs exhibited suboptimal diagnostic accuracy in at least one of six "life-threatening" clinical cases among two sets of 10 clinical images of pigmented skin lesions, which can lead to inadequate patient management (i.e. incorrect treatment and/or inappropriate reinsurance). This study underlines the need to train GPs in melanoma diagnosis. GPs' pigmented skin lesion diagnostic accuracy and management should be improved to increase early melanoma detection.
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Affiliation(s)
- E Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - C Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - S Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - C Bugli
- Statistical Methodology and Computing Service (SMCS), Louvain-la-Neuve, Belgium
| | - L Thomas
- Dermatology Department, Lyon Cancer Research Center INSERM, Université Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - M Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - I Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Abstract
BACKGROUND General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time. OBJECTIVES This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs' acquired skills. ELIGIBILITY CRITERIA Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020. RESULTS Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material. CONCLUSION This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.
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Affiliation(s)
- Evelyne Harkemanne
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Marie Baeck
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Isabelle Tromme
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Clinique du mélanome, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
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Gimenez L, Druel V, Roques S, Vasseur J, Grosclaude P, Delpierre C, Rouge-Bugat ME. Inventory of tools for care coordination between general practice and hospital system for patients suffering from cancer in active phase of treatment: A scoping review. Eur J Cancer Care (Engl) 2020; 29:e13319. [PMID: 32930478 DOI: 10.1111/ecc.13319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During the active phase of treatment, major difficulties appear in the transmission and quality of the information communicated to the General Practitioner (GP). Our objective was to carry out an inventory of the coordination tools used to improve exchanges between the hospital and the GP in the management of the patient suffering from cancer during this phase. MATERIAL AND METHOD A scoping review was conducted using MEDLINE databases via PubMed, The Cochrane Library, Web of Science. Articles published between 1998 and 2018, in English and French, were analysed. RESULTS Over 4,863 articles were extracted, and 11 studies were included. They highlight an increase in the quality of patient care after the introduction of information sheets or training by video vignettes with GPs. They demonstrate the importance of using standardised letters between health professionals. The role of a "leader physician" is discussed, and its first evaluations are positive. An increase in information transmitted to GPs leads to a better satisfaction of patients and GPs. CONCLUSION Communication tools are essential for the transmission of information, but direct and oral communication between all health professionals seems to be a point to be further developed.
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Affiliation(s)
- Laëtitia Gimenez
- Département Universitaire de Médecine Générale, Université Toulouse III Paul Sabatier, Toulouse Cedex, France.,UMR 1027 INSERM - Université Toulouse III Paul Sabatier, Faculté de médecine, Toulouse, France.,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Vladimir Druel
- Département Universitaire de Médecine Générale, Université Toulouse III Paul Sabatier, Toulouse Cedex, France.,UMR 1027 INSERM - Université Toulouse III Paul Sabatier, Faculté de médecine, Toulouse, France
| | - Sandra Roques
- Département Universitaire de Médecine Générale, Université Toulouse III Paul Sabatier, Toulouse Cedex, France
| | - Jonathan Vasseur
- Département Universitaire de Médecine Générale, Université Toulouse III Paul Sabatier, Toulouse Cedex, France
| | - Pascale Grosclaude
- UMR 1027 INSERM - Université Toulouse III Paul Sabatier, Faculté de médecine, Toulouse, France.,Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, France
| | - Cyrille Delpierre
- UMR 1027 INSERM - Université Toulouse III Paul Sabatier, Faculté de médecine, Toulouse, France
| | - Marie-Eve Rouge-Bugat
- Département Universitaire de Médecine Générale, Université Toulouse III Paul Sabatier, Toulouse Cedex, France.,UMR 1027 INSERM - Université Toulouse III Paul Sabatier, Faculté de médecine, Toulouse, France.,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France.,Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, France
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Zimmerlé V, Laurent E, Tauveron V, Maruani A, Le Bidre E, Samimi M, Machet L. [Recognition and initial management of melanoma by general practitioners: A survey in a rural French area with low medical density]. Presse Med 2018; 47:e35-e42. [PMID: 29555164 DOI: 10.1016/j.lpm.2017.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cutaneous cancers are very common, easily visible on skin. The general practitioner (GP) is in the front line to manage the lesions. He has to recognize malignancy and refer most often to the specialist for excision, or consider that the lesion is benign and in ambiguous cases, offer clinical monitoring. The current low medical density in the Centre Val de Loire area makes access to general practitioners (GP) and dermatologists harder. The aim of this study was to evaluate GPs' everyday practice in cutaneous cancers screening in general, and particularly in melanoma screening, in a rural region of France. METHODS We sent a questionnaire on November 24th 2015 to all GPs of the Cher department (204 questionnaires), to assess their knowledge and practice of melanoma. The questionnaire comprised 2 parts: the first part was composed of 23 items with a majority of questions focused on melanoma and the second part consisted of clinical cases including 5 benign cutaneous tumors, 4 melanomas and 1 pigmented basal cell carcinoma. GP's were asked to answer in each case: diagnosis, degree of certainty (from 0 to 10), practical attitude (excision, referral to dermatologist or surgeon or surveillance). Their answers were anonymous. The primary endpoint was whether medical decision regarding each case was appropriate, i.e. removal of malignant lesion or referral for removal, and reassurance or surveillance in benign lesions. RESULTS The response rate was 35% (72 responses). Thirty-eight GPs (53%) had an appropriate management facing the 5 malignant lesions, 18 GP (25%) had an appropriate management in 4 out of 5 cases. The ABCDE rule was known by 58% of responders, the ugly duckling sign of 19%. GPs did not feel comfortable with melanoma: on a growing scale (from 0=not comfortable at all to 10=very comfortable) the average was 4.2 with a median at 5 (range 0-10). They expressed a strong need for training on this topic: on a scale increasing from 0 to 10, the average was 7.9 for a median to 8 (range 3-10). Knowledge about melanoma risk factors, and the level of ease dealing with screening of melanoma was not significantly associated with a better management. The main difficulties were lack of time and the increasing difficulty of access to dermatologist. Fast and easy access by teledermatology was solicited by 89% of GPs. CONCLUSION GPs had often appropriate management of skin cancer. The major obstacles to skin's cancer screening were the lack of time and difficult access to dermatologists. The setting-up of an easier access with teledermatology was requested by 89% of responders, and should improve early detection of melanoma.
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Affiliation(s)
- Valérie Zimmerlé
- CHRU de Tours, service de dermatologie, 37044 Tours, France; Université de Tours, département de médecine générale, 37032 Tours, France
| | - Emeline Laurent
- CHRU de Tours, service d'épidémiologie et biostatistiques, 37044 Tours, France
| | | | | | | | - Mahtab Samimi
- CHRU de Tours, service de dermatologie, 37044 Tours, France
| | - Laurent Machet
- CHRU de Tours, service de dermatologie, 37044 Tours, France; Université de Tours, Inserm U1253, iBrain, 37032 Tours, France.
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Moscarella E, Lallas A, Longo C, Alfano R, Argenziano G. Five-point checklist for skin cancer detection in primary care. GIORN ITAL DERMAT V 2017; 154:523-528. [PMID: 28209049 DOI: 10.23736/s0392-0488.17.05565-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Skin cancer screening interventions often relay on the involvement of general practitioners (GPs). Many interventions up to now have been directed to training approaches focusing on the clinical features of skin malignancies to increase GPs skill in skin cancer recognition. METHODS Based on the available current knowledge about skin cancer epidemiology and risk factors, we built up a 5-point checklist to help GPs in triaging patients to be referred to a dermatologist. RESULTS Five-point check-list: 1) visible sun damaged skin on exposed areas (red and brown to black macules and crusts on visible skin); 2) more than 20 nevi on the arms; 3) one or more ABCD positive lesions (flat, large and asymmetric macules); 4) one or more EFG positive lesions (elevated, firm and growing skin lesions); 5) a pigmented lesion larger than 1.5 cm in diameter. CONCLUSIONS Our aim was to provide a short list of practical rules, easy to adopt into a routine practice, in order to achieve a more effective triage of patients requiring a dermatology consultation for skin cancer examination. The novelty of the proposed method relies on the approach. The proposed method does not require the GP to diagnose skin cancer. The aim is to involve GPs in the selection of patients to be referred to the specialist, in order to reduce the waiting time while avoiding the risk to leave cancers untreated.
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Affiliation(s)
- Elvira Moscarella
- Unit of Dermatology and Skin Cancer, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy -
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Caterina Longo
- Unit of Dermatology and Skin Cancer, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, Luigi Vanvitelli University of Campania, Naples, Italy
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Rat C, Grimault C, Quereux G, Dagorne M, Gaultier A, Khammari A, Dreno B, Nguyen JM. Proposal for an annual skin examination by a general practitioner for patients at high risk for melanoma: a French cohort study. BMJ Open 2015; 5:e007471. [PMID: 26224016 PMCID: PMC4521510 DOI: 10.1136/bmjopen-2014-007471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a targeted screening for melanoma in high-risk patients following the receipt of a mailed invitation to an annual skin examination by a general practitioner (GP). METHODS A prospective cohort study was conducted in a primary care setting in western France. A total of 3897 patients at elevated risk of melanoma (identified using the Self-Assessment of Melanoma Risk Score) consented to participate in a targeted melanoma screening project in 2011. One year later, the participants were invited by mail to consult their GP for an annual skin examination. Efficacy of the procedure was evaluated according to patient participation and the number of melanomas detected. The consultation dates and results were collected during the 12 months postreminder and were analysed using SAS. Analyses of whether participation decreased compared with that during the year of inclusion and whether populations at risk for thick melanoma showed reduced participation in the screening were performed. RESULTS Of the 3745 patients who received the mailed invitation, 61% underwent a skin examination. The participation of patients at risk for thick melanoma (any patient over 60 years of age and men over 50 years of age) was significantly greater than that of the patients in the other subgroups (72.4% vs 49.6%, p<0.001; and 66% vs 52.4%, p<0.001, respectively). The patients referred to the dermatologist after 1 year were more compliant compared with those referred during the first year (68.8% vs 59.1%, p=0.003). Six melanomas were detected within 1 year postreminder; therefore, the incidence of melanoma in the study population was 160/100 000. CONCLUSIONS This study confirms the benefits of developing a targeted screening strategy in primary care. In particular, after the annual reminder, patient participation and the diagnosis of melanoma remained high in the patients at elevated risk of thick melanomas. TRIAL REGISTRATION NUMBER NCT01610531.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes, France
- French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)—Team 2, Nantes, France
| | | | - Gaelle Quereux
- French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)—Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Maelenn Dagorne
- Department of General Practice, Faculty of Medicine, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Amir Khammari
- French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)—Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Brigitte Dreno
- French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)—Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)—Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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Grange F, Woronoff AS, Bera R, Colomb M, Lavole B, Fournier E, Arnold F, Barbe C. Efficacy of a general practitioner training campaign for early detection of melanoma in France. Br J Dermatol 2015; 170:123-9. [PMID: 23937244 DOI: 10.1111/bjd.12585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, no strategy for improving early diagnosis of melanoma has been evaluated on a population basis in France. OBJECTIVE To evaluate the efficacy of a general practitioner (GP) awareness and training campaign in a pilot French geographical region (Champagne-Ardenne), including 1.34 million inhabitants, 1241 GPs, 56 dermatologists and a population-based melanoma registry. METHODS All GPs received repeated awareness postal mailings in 2008 and 398 (32.1%) attended training sessions organized by 27 dermatologists. The pre- (2005-7) and post-campaign (2009-11) periods were compared for the following: primary endpoint - the world-standardized incidence of very thick melanomas (VTM) (Breslow thickness ≥ 3 mm); secondary endpoints--the mean Breslow thickness; the proportions of VTM and of thin (< 1 mm) melanomas among invasive cases; and the ratio of in situ/all melanoma cases. Similar measures were performed in the control area of Doubs/Belfort territory (655,000 ha), where no similar campaign was carried out. RESULTS The incidence of VTM decreased from 1.07 to 0.71 per 100 000 habitants per year (P = 0.01), the mean Breslow thickness from 1.95 to 1.68 mm (P = 0.06) and the proportion of VTM from 19.2% to 12.8% (P = 0.01). The proportion of thin and in situ melanomas increased from 50.9% to 57.4% (P = 0.05) and from 20.1% to 28.2% (P = 0.001), respectively. No significant variation was observed in Doubs/Belfort territory. CONCLUSION These results strongly support the efficacy of such a campaign targeting GPs and provide a rationale for a larger public health campaign in France, including training of GPs by dermatologists and encouraging patients to ask their GP for a systematic skin examination.
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Affiliation(s)
- F Grange
- Service de Dermatologie, Hôpital Robert Debré, Reims, France
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12
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Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part II. Screening, education, and future directions. J Am Acad Dermatol 2014; 71:611.e1-611.e10; quiz 621-2. [PMID: 25219717 DOI: 10.1016/j.jaad.2014.05.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 11/22/2022]
Abstract
New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.
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13
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Senan Sanz MR, Olona Tabueña N, Magallón Botaya R, Gilaberte Calzada Y. [Prevention of skin cancer: a task still to be addressed in primary care]. Aten Primaria 2014; 46:223-4. [PMID: 24246744 PMCID: PMC6983643 DOI: 10.1016/j.aprim.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/22/2013] [Accepted: 08/29/2013] [Indexed: 11/25/2022] Open
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14
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Saiag P. Toward a new place for dermatologists in the diagnosis of melanoma in France? Br J Dermatol 2012. [DOI: 10.1111/bjd.12090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P. Saiag
- Service de Dermatologie Générale et Oncologique, Faculty of Medicine Paris‐Ile de France Ouest, University of Versailles‐SQY, Hôpital A Paré, 92104 Boulogne Cedex, France
E‐mail:
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