Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

Dorothy Drabarek; Emily Habgood; Monika Janda; Jolyn Hersch; Deonna Ackermann; Don Low; Cynthia Low; Rachael L Morton; Mbathio Dieng; Anne E Cust; Adelaide Morgan; Elloise Smith; Katy L J Bell

doi:10.2196/35916

Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

JMIR Dermatol. 2022 Jul 1;5(3):e35916. doi: 10.2196/35916.

Authors

Dorothy Drabarek^#¹, Emily Habgood^#², Monika Janda³, Jolyn Hersch¹, Deonna Ackermann¹, Don Low⁴, Cynthia Low⁴, Rachael L Morton⁵, Mbathio Dieng⁵, Anne E Cust^{1

6

7}, Adelaide Morgan¹, Elloise Smith¹, Katy L J Bell¹

Affiliations

¹ Sydney School of Public Health, University of Sydney, Sydney, Australia.
² Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
³ Centre for Health Services Research, University of Queensland, Brisbane, Australia.
⁴ Cancer Voices NSW, Sydney, Australia.
⁵ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
⁶ The Daffodil Centre, The University of Sydney Cancer Council NSW, Sydney, Australia.
⁷ Melanoma Institute Australia, The University of Sydney, Sydney, Australia.

^# Contributed equally.

PMID: 37632893
PMCID: PMC10334928
DOI: 10.2196/35916

Abstract

Background: Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation.

Objective: This study aims to explore patients' experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care.

Methods: Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model.

Results: We interviewed 20 patients (n=8, 40% women and n=12, 60% men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness.

Conclusions: Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.

Keywords: digital technologies; mHealth; melanoma; mobile phone; self-surveillance; teledermatology; teledermoscopy.

©Dorothy Drabarek, Emily Habgood, Monika Janda, Jolyn Hersch, Deonna Ackermann, Don Low, Cynthia Low, Rachael L Morton, Mbathio Dieng, Anne E Cust, Adelaide Morgan, Elloise Smith, Katy L J Bell. Originally published in JMIR Dermatology (http://derma.jmir.org), 01.07.2022.