Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants

• Published in: PloS one Vol. 18; no. 12; p. e0287591
• Main Authors: Dunlop, Kate L A, Keogh, Louise A, Smith, Andrea L, Aranda, Sanchia, Aitken, Joanne, Watts, Caroline G, Smit, Amelia K, Janda, Monika, Mann, Graham J, Cust, Anne E, Rankin, Nicole M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-12-2023; Public Library of Science (PLoS)
• Subjects: Acceptability; Cancer; Cancer screening; Care and treatment; Chronic diseases; Consumers; Dermatology; Diagnosis; Effectiveness; Evaluation; Family medicine; Health aspects; Informers; Interviews; Medical care, Cost of; Medical personnel; Medical screening; Medicine and Health Sciences; Melanoma; Mortality; Oncology, Experimental; Population; Professionals; Public health; Qualitative research; Risk assessment; Risk factors; Risk groups; Risk perception; Skin; Skin cancer; Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0287591

In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers.
This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist.
Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging.
Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.