Melanoma risk assessment and management: a qualitative study among Australian GPs

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Balakumar Anandasivam¹  Chun Wah Michael Tam²  Kevin McGeechan³  Karen Price⁴  Katrina McLean⁵  Marguerite Tracy³  John Hall⁶  Andrew Knight⁷  Kylie Vuong⁸ 

[1] Port Macquarie Rural Clinical School, Faculty of Medicine, University of New South Wales;School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, director, Primary and Integrated Care Unit, South Western Sydney Local Health District;School of Public Health, Faculty of Medicine and Health, University of Sydney;Department of General Practice, Monash University, Melbourne, president, Royal Australian College of General Practitioners;Faculty of Health Sciences and Medicine, Bond University;School of Population Health, Faculty of Medicine, University of New South Wales;School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, staff specialist, Primary and Integrated Care Unit, South Western Sydney Local Health District;School of Medicine and Dentistry, Griffith University, Gold Coast, adjunct associate professor, School of Population Health, Faculty of Medicine, University of New South Wales

关键词: general practitioners;    melanoma;    qualitative research;    risk assessment;    primary health care;    Australia;   

DOI  :  10.3399/BJGP.2021.0668

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. To the authors’ knowledge, there has been no previous research into how all physicians approach the selection and management of high-risk individuals. Melanoma risk-prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically.Aim To examine how GPs assessed and managed melanoma risk, and the opportunities for using melanoma risk-prediction models in primary care.Design and setting Semi-structured telephone interviews were conducted with 20 Australian GPs.Method GPs who had completed a cross-sectional online questionnaire study on melanoma risk were purposively sampled and recruited. Semi-structured telephone interviews were conducted with Australian GPs between 9 July and 10 September 2019. Interviews were audiorecorded, professionally transcribed, and analysed using grounded theory.Results Melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between GPs on the identification of melanoma risk factors, melanoma risk estimation, management, and patient education because of intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk-prediction models, sharing facilitators for and barriers to their potential implementation.Conclusion Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk-assessment and management processes.

【 授权许可】

Free