A digital intervention to improve skin self-examination among melanoma survivors

改善黑色素瘤幸存者皮肤自我检查的数字干预

• 批准号: 10593971
• 负责人: Carolyn Heckman
• 金额: $ 63.81万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593971
• 关键词: Address; Adoption; Behavior; Behavioral; Cancer Science; Cancer Survivor; Cancer Survivorship; Caring; Clinical; Collaborations; Community Healthcare; Consent; Cost Analysis; Cost Effectiveness Analysis; Cutaneous Melanoma; Data; Detection; Diagnosis; Disease; Disease Progression; Dissemination and Implementation; Early Diagnosis; Early treatment; Education; Effectiveness; Eligibility Determination; Ensure; Future; General Population; Goals; Guidelines; Healthcare; Immunotherapy; Incidence; Intervention; Interview; Lesion by Stage; Maintenance; Malignant Neoplasms; Methods; Modeling; New Jersey; Newly Diagnosed; Participant; Performance; Persons; Physicians; Population; Prevention; Process; Professional Organizations; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Recurrence; Recurrent Malignant Neoplasm; Recurrent disease; Research; Resources; Risk; Risk Factors; Risk Reduction; Self-Examination; Skin; Skin Cancer; Survivors; Target Populations; Techniques; Testing; Theory of Change; Thinness; Time; Treatment Cost; Underserved Population; United States; Work; behavior change; cancer diagnosis; cancer recurrence; care providers; clinical examination; contextual factors; cost; cost effective; cost effectiveness; design; digital intervention; effective therapy; effectiveness evaluation; effectiveness/implementation design; effectiveness/implementation trial; efficacy trial; experience; follow-up; future implementation; health care settings; high risk; implementation evaluation; implementation framework; implementation outcomes; implementation science; improved; informant; innovation; intervention delivery; melanoma; models and simulation; neoplasm registry; online intervention; program costs; programs; recruit; scale up; social media; treatment as usual; trial design; usability; web page

ABSTRACT With incidence rates more than tripling in the last 45 years, the population of melanoma survivors in the US is estimated at more than a million persons. Survivors are at elevated risk for recurrence and new primary cancers. Most recurrent melanomas are found by survivors themselves, which is why physicians educate survivors about the importance of regular, thorough skin self-exams (SSE) and why professional guidelines for follow-up surveillance recommend regular, thorough (SSE). More than two thirds of melanoma survivors do not perform regular, thorough SSE. To address this significant problem, our experienced team developed a digital intervention, called mySmartSkin (MSS), and tested it in an RCT against usual care in New Jersey. MSS illustrated promising effects on thorough SSE. In this application, we propose to prepare MSS for large-scale dissemination using an innovative Type 1 hybrid effectiveness-implementation trial. A Type 1 hybrid effectiveness-implementation design allows us to engage multilevel stakeholders throughout the research process, evaluate the effectiveness of the enhanced MSS, and identify critical factors for wide-scale implementation. The study’s three aims are guided by implementation frameworks and behavior change theories. In Aim 1, we will enhance MSS using multi-level stakeholder engagement by collaborating with key stakeholders in enhancing MSS through qualitative interviews and usability testing of potential enhancements. Potential enhancements are based on empirically-validated behavior change techniques (BCTs) and findings from our prior study. We will utilize an iterative process that includes key informant interviews with survivors, providers, and relevant professional organizations regarding proposed enhancements, conversion to an enhanced mobile-based intervention delivery platform, usability testing with survivors, and iterative program refinements. Aim 2 compares the effects of enhanced MSS vs. a non-interactive educational webpage on comprehensive SSE in an RCT with survivors recruited through two state cancer registries and social media (N=300). In Aim 3, we identify factors relevant to future scale-up for widespread dissemination and implementation using mixed methods to assess selected implementation outcomes from the RCT and explore perspectives from survivors, care providers, and professional organizations about how to best disseminate and implement MSS on a broad scale. We will estimate program costs and assess cost-effectiveness of MSS. This project addresses a documented gap in care for melanoma survivors by enhancing effects of a promising survivor-facing intervention and proactively identifying barriers and facilitators to future implementation. We innovatively “design for dissemination” by ensuring that enhancements are designed with the target population of potential users. Serving as a model for optimizing promising fully-automated online interventions for cancer survivors for dissemination, this project will provide important information about potentially cost-effective ways to reach survivors as well as about how to adapt such an intervention for dissemination.

抽象的 过去 45 年中，美国黑色素瘤幸存者的发病率增加了两倍多 估计超过一百万人的复发和新原发性风险较高。 大多数复发性黑色素瘤是幸存者自己发现的，这就是医生进行教育的原因。 幸存者了解定期、彻底的皮肤自我检查 (SSE) 的重要性以及为什么需要专业指南 建议定期、彻底的随访监测（SSE） 超过三分之二的黑色素瘤幸存者不这样做。 为了解决这个重大问题，我们经验丰富的团队开发了一个数字化系统。 名为 mySmartSkin (MSS) 的干预措施，并在新泽西州的一项随机对照试验中针对常规护理进行了测试。 展示了对彻底的 SSE 的有希望的效果。在这个应用中，我们建议为大规模的 MSS 做准备。 使用创新的 1 型混合有效性实施试验进行传播。 有效性实施设计使我们能够在整个研究过程中吸引多层次的利益相关者 过程，评估增强型 MSS 的有效性，并确定大规模实施的关键因素 该研究的三个目标以实施框架和行为改变为指导。 在目标 1 中，我们将通过与关键利益相关者合作，利用多层次的利益相关者参与来增强 MSS。 利益相关者通过定性访谈和潜在增强功能的可用性测试来增强 MSS。 潜在的增强功能基于经过经验验证的行为改变技术 (BCT) 和调查结果 根据我们之前的研究，我们将利用一个迭代过程，其中包括对幸存者的关键信息采访， 提供商和相关专业组织就拟议的增强功能、转换为 增强的基于移动设备的干预实施平台、幸存者可用性测试和迭代计划 目标 2 比较了增强型 MSS 与非交互式教育网页的效果。 通过两个州癌症登记处和社交媒体招募幸存者的随机对照试验中的综合 SSE (N=300) 在目标 3 中，我们确定了与未来扩大规模以进行广泛传播和相关的因素。 使用混合方法来评估随机对照试验中选定的实施结果并探索实施 幸存者、护理提供者和专业组织关于如何最好地传播和 我们将估算计划成本并评估 MSS 的成本效益。 该项目通过增强有前途的药物的效果，解决了黑色素瘤幸存者护理方面记录在案的差距。 面向幸存者的干预措施，并主动识别未来实施的障碍和促进因素。 通过确保针对目标人群设计增强功能，创新地“传播设计” 作为优化有前途的全自动在线癌症干预措施的模型。 为了传播幸存者，该项目将提供有关潜在具有成本效益的方法的重要信息 接触幸存者以及如何调整这种干预措施以进行传播。