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Skin Cancer Education for Primary Care Physicians: A Systematic Review of Published Evaluated Interventions

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ABSTRACT

BACKGROUND

Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting.

OBJECTIVE

We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma.

DESIGN

Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary.

APPROACH

Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes.

KEY RESULTS

All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics.

CONCLUSIONS

Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.

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Contributors

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Funders

This study was supported in part by a research grant from the Melanoma Research Alliance. The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

Prior presentations

None.

Conflict of Interest

Jacqueline M. Goulart, BA, Stephen Dusza, DrPH, Gwen Alexander, PhD, Melody J. Eide, MD, Ashfaq A. Marghoob, MD, and Allan C. Halpern, MD, have nothing to disclose. Elizabeth A. Quigley, MD, reports honoraria received from Novartis Pharmaceuticals in 2009 and 2010 for skin screening and employee-health lectures. Maryam M. Asgari, MD, reports a grant received from Novartis Pharmaceuticals (2009). Suzanne W. Fletcher, MD, MSc, reports stock ownership of Berkshire Hathaway and honoraria received from UpToDate (editor, primary care) and Wolters-Kluwer (author, Clinical Epidemiology-The Essentials). Alan C. Geller, MPH, reports honoraria from UpToDate (author, skin cancer). Martin A. Weinstock, MD, PhD, reports employment by University Dermatology Inc.; consultancies for Abbott, Astellas, Conrail, Johnson&Johnson, Nordic Biotech, Roche, Schering; and expert testimony for Playtex.

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Authors and Affiliations

  1. Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jacqueline M. Goulart BA, Elizabeth A. Quigley MD, Stephen Dusza DrPH, Ashfaq A. Marghoob MD & Allan C. Halpern MD

  2. Medical Library, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sarah T. Jewell MLIS

  3. Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI, USA

    Gwen Alexander PhD & Melody J. Eide MD

  4. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Maryam M. Asgari MD

  5. Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA

    Melody J. Eide MD

  6. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Suzanne W. Fletcher MD, MSc

  7. Division of Public Health Practice, Harvard School of Public Health, Boston, MA, USA

    Alan C. Geller MPH

  8. Dermatoepidemiology Unit, Veterans Affairs Medical Center, Providence, RI, USA

    Martin A. Weinstock MD, PhD

  9. Department of Dermatology, Rhode Island Hospital, Providence, RI, USA

    Martin A. Weinstock MD, PhD

  10. Departments of Dermatology and Community Health, Brown University, Providence, RI, USA

    Martin A. Weinstock MD, PhD

  11. Dermatology Service, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd, Basking Ridge, NJ, 07920, USA

    Elizabeth A. Quigley MD

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  1. Jacqueline M. Goulart BA
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INFORMED (INternet curriculum FOR Melanoma Early Detection) Group

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Correspondence to Elizabeth A. Quigley MD.

Additional information

Members of the INFORMED Group include: Gwen Alexander, PhD; Maryam M. Asgari, MD; Melody J. Eide, MD; Suzanne W. Fletcher, MD, MSc; Alan C. Geller, MPH; Allan C. Halpern, MD; and Martin A. Weinstock, MD, PhD

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Goulart, J.M., Quigley, E.A., Dusza, S. et al. Skin Cancer Education for Primary Care Physicians: A Systematic Review of Published Evaluated Interventions. J GEN INTERN MED 26, 1027–1035 (2011). https://doi.org/10.1007/s11606-011-1692-y

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