Skip to main content

Feasibility of a GP delivered skin cancer prevention intervention in Australia

Abstract

Background

Despite years of public education, sun-related behaviours are difficult to change and a recent survey showed low levels of sun protection. In this study we evaluated the feasibility and acceptability of an opportunistic skin cancer prevention intervention in general practice.

Methods

We used a controlled pre-and-post intervention design. Participants (nā€‰=ā€‰100) were recruited sequentially from patients attending two general practices in Sydney, Australia, from November to December 2010. Participants in the intervention practice (nā€‰=ā€‰50) received general practitioner delivered sun protection advice after completing a skin cancer risk assessment tool, and a sun protection pamphlet, in addition to routine care, at a single attendance. The skin cancer risk assessment tool provided three levels of risk. The general practitioner (GP) reinforced the level of risk and discussed sun protection. Participants in the control practice (nā€‰=ā€‰50) received routine care. We measured feasibility by patientsā€™ and GPsā€™ participation in the intervention and time taken, and acceptability by intervention participants and GPs ratings of the intervention. We measured reported sun-related knowledge, attitudes and behaviour between the two groups at 1 and 13Ā months.

Results

The intervention was found to be feasible within existing primary care team arrangements. Participation at baseline was 81% (108/134), and repeated participation was 88% (88/100) at 1Ā month and 70% (70/100) at 13Ā months. Participants and practitioners found the intervention acceptable. At 1Ā month, sun-related knowledge had increased in both patient groups, with a greater increase in the intervention group (adjusted mean difference 0.48, pā€‰=ā€‰0.034). There were no differences between groups in sun-related knowledge, attitudes and behaviour at 13Ā months.

Conclusions

A brief opportunistic skin cancer prevention intervention in general practice is feasible and acceptable. Further research in this setting with a more intensive intervention would be justified.

Peer Review reports

Background

Skin cancer, which includes basal cell carcinoma, squamous cell carcinoma and melanoma is the most expensive cancer in Australia [1]. Prevention guidelines recommend reducing exposure to ultraviolet (UV) radiation, wearing protective clothing, wearing a hat, and using sunscreen during peak UV periods [2]. Despite more than 25Ā years of public education, [3, 4] a national survey of 5,412 adult respondents showed low levels of sun protection [5]. Further interventions in skin cancer prevention are needed.

Primary care-relevant counselling is associated with moderate improvements in sun protection behaviours; however these improvements are of uncertain clinical relevance [6]. For adults over 24Ā years, there is inadequate evidence to assess the benefits of behavioural counselling on sun protection and skin cancer prevention [7]. The US Preventive Services Task Force recommends further research on the effectiveness of counselling on sun protection behaviours and the development of new ways of administering interventions to address this evidence gap [7].

Health information that is informed by a personā€™s unique characteristics may be effective [8]. In primary care settings, skin cancer prevention interventions have included mailed packages [9, 10] and interactive computer-based education [11]. However there are few studies that have directly evaluated physician-delivered feedback interventions on patientsā€™ sun protection. In an early study, 37% of the intervened sample began using sun protection factor 15 sunscreen following repetitive sun protection advice given by a dermatologist [12]. More recently, greater changes in sunscreen use were shown in a group who received sun protection advice from a general practitioner (GP) in a 20Ā minute consultation compared to a group who received the advice by means of a letter [13, 14].

General practiceā€™s focus on comprehensive whole-person care and the steady flow of skin cancer related attendances make it an ideal setting for skin cancer prevention [15, 16]. We aimed to evaluate the feasibility and acceptability of a brief skin cancer prevention intervention delivered opportunistically, and measure sun-related knowledge, attitudes and behaviour.

Methods

The study was a pre-post design with a control group. Participants were surveyed on their sun-related knowledge, attitudes and behaviours immediately before intervention, and at 1 and 13Ā months later.

Participants

General practitioners participants

A practice-based intervention was selected to limit potential contamination; two general practices volunteered. Both practices had past research participation and fulfilled our selection criteria: willingness of the GPs to participate and a sizeable waiting room. The intervention practice, located in the Australian State of New South Walesā€™ Leichhardt local government area (Index of Relative Socioeconomic Disadvantage scoreā€‰=ā€‰1078.9, which ranks it in the highest 10% of the State for socioeconomic status of its residents), [17] employed 9 GPs, 6 full-time and 3 part-time, 6 female and 3 male. The control practice, located in the Ashfield local government area (Index of Relative Socioeconomic Disadvantage scoreā€‰=ā€‰1015.4, which ranks it in the highest 30% of the State), [17] employed 8 full-time GPs, 4 female and 4 male.

Patient participants

Individual participants were recruited from November to December 2010 in the practice waiting room. To minimise disruption to practice operations, a research assistant screened ā€œthe most recent patient to enter the waiting roomā€ for eligibility and invited eligible patients to participate. Recruitment was stratified with a notional quota for each half-day session of 12 patients equally distributed by sex and age (less than 50Ā years old or greater than 50Ā years old) for each session. We included patients across all skin cancer risk categories [18, 19]. To be eligible, a patient had to be aged over 18Ā years, have the capacity to give meaningful consent and be well enough to participate. Ethical approval (No. 13129) was obtained from The University of Sydney Human Research Ethics Committee and informed consent was obtained from all participants.

Intervention

The intervention involved a skin cancer risk assessment tool, GPs delivering sun protection advice informed by the patientā€™s skin cancer risk and a SunSmart UV Alert pamphlet [20].

Protection motivation theory, [21] shown to be effective in promoting sun protection, [22ā€“24] provided the theoretical framework for our study. Protection motivation theory proposes that, when individuals are confronted with a health threat (skin cancer risk), they engage in two cognitive processes: threat appraisal and coping appraisal [21]. Components of threat appraisal include severity (perceived seriousness of skin cancer) and vulnerability (perceived risk of skin cancer); components of coping appraisal include response efficacy (perceived effectiveness of sun protection behaviours) and self-efficacy (oneā€™s ability to execute the recommended prevention); motivation to protect oneā€™s self is the mediating variable that directs behaviours [21]. The intervention aimed to improve sun protection behaviours by strengthening the perceived threat from skin cancer together with strong coping messages.

GPs in the intervention group were briefed collectively at 1Ā month and individually at 1Ā week before recruitment began on the skin cancer risk assessment tool, the delivery of sun protection advice and the SunSmart UV Alert pamphlet [20]. The skin cancer risk assessment tool was adapted from existing tools [25ā€“27]. It provided for three levels of risk based on hair colour, skin colour, sun sensitivity, the presence of moles and personal skin cancer history (Additional file 1). Patients in the intervention group completed, unassisted, the skin cancer risk assessment tool in the waiting room and showed it to their GP in the consultation immediately following recruitment. The GPs reinforced the patientsā€™ level of risk from the skin cancer risk assessment and discussed sun protection including sunscreen use, use of protective clothing, the importance of wearing a broad-brimmed hat, use of shade and the UV index. Each intervention patient was provided with a copy of the skin cancer risk assessment tool and a SunSmart UV Alert pamphlet [20]. The SunSmart UV Alert pamphlet included information on UV radiation, the UV index, and on sun protection [20].

Patients in the control group also completed the skin cancer risk assessment; which appeared at the end of the baseline survey. The assessment did not include any risk levels or sun protection advice and the research assistant collected it with the completed baseline survey before the GP consultation. Control patients received usual GP care; i.e. the GPs were not given any specific instructions on providing skin cancer prevention advice and provided counselling at their own discretion. In a study of US family physicians, skin cancer prevention formed a small part of the preventive workload with skin cancer prevention advice offered in only 1% of patient visits [28]. There are no corresponding Australian data.

Measures of feasibility

Feasibility studies are small scale studies conducted to test new research plans and inform the development of larger scale studies [29, 30]. Feasibility studies usually address four main components of a proposed study: process, testing the steps that are key to the success of the study; resources, assessing time and budget requirements; management, assessing human and data management needs; and scientific, assessing the likely effect of the intervention [29]. Our feasibility study focused on processes and resources. We assessed rate of invited patientsā€™ participation in the intervention and reasons for non-participation; and the time required for participants to complete the skin cancer risk assessment tool and for the GP to deliver the sun protection advice.

Measures of acceptability

To access acceptability, intervention group patients were asked in the follow-up survey to rate the intervention materials using a four-point Likert scale. The questions about the skin cancer risk assessment tool were: ā€œHow useful did you find the skin cancer risk checklist that was given to you in the waiting room?ā€ and ā€œHow easy was it to complete this skin cancer risk checklist?ā€ The question on the sun protection advice was: ā€œHow useful did you find these discussions?ā€ The questions on the SunSmart UV Alert pamphlet [20] were: ā€œHow useful did you find the sun protection pamphlet that was given to you by the GP?ā€ and ā€œWas the sun protection pamphlet easy to read?ā€

Intervention group GPs were individually interviewed in February 2011. The interview was structured around sun protection advice, skin cancer risk assessment tool, and SunSmart UV Alert pamphlet [20].

Measures of sun protection knowledge, attitudes and behaviours

A sun habits survey was adapted from existing surveys (Additional file 2) [31, 32]. Participants completed, unassisted, a baseline survey in the waiting room before seeing the GP and follow up surveys at home at 1 and 13Ā months later. Each survey collected the same data on sun-related knowledge, attitudes and behaviours.

Sun-related knowledge was measured with six items using a true-false format (Items 1-6, Additional file 2). Each correct answer to a knowledge question contributed one point to a composite knowledge score. Higher scores reflect higher knowledge levels. The Cronbach alpha coefficient for the composite knowledge score was 0.38.

Sun-related attitudes, as key components of protection motivation theory, were measured using a five-point Likert scale. Perceived severity (Items 8, 9 and 10, Additional file 2), vulnerability (Items 11 and 12, Additional file 2) and self-efficacy (Items 14, 15 and 16, Additional file 2) were represented by a composite score. Response-efficacy (Item 13, Additional file 2) was represented by a single-item score. Higher scores reflect more favourable sun-related attitudes. The Cronbach alpha coefficients for the composite severity, vulnerability and self-efficacy scores were 0.46, 0.87 and 0.61 respectively.

Sun exposure was measured by asking participants to indicate the number of hours they usually spent outdoors without reference to a specific time period (Item 26, Additional file 2). Sun-related behaviours, including sunscreen use, wearing a hat, wearing a long sleeve shirt, wearing sunglasses and limiting time in the sun, were measured using a five-point Likert scale and summed as a sun protection score. The Cronbach alpha coefficient for the sun protection score was 0.65.

Statistical methods

Multiple linear regression modelling was used to assess differences between intervention and control groups in their responses to the follow-up surveys after controlling for the baseline (first survey) value of the variable being compared, age and sex. The other baseline variables were entered into the model to test whether they contributed to the predictive ability of the model. Adjusted mean values were obtained using one-way analysis of covariance. Data analyses were conducted using SPSS-19 statistical software [33].

Results

Characteristics of participants

FigureĀ 1 shows the recruitment of participants. Among the patients who were screened and invited to participate, three were ineligible because they did not have the capacity to offer meaningful consent and one because she did not have an appointment to see the GP. Twenty two patients refused, reasons offered included being busy (12 patients) and high compliance with sun protection (2 patients). Among the 58 intervention group patients who consented to participate, 8 were called in by their GPs before they completed the baseline sun habit survey and skin cancer risk assessment tool, and therefore not enrolled.

Figure 1
figure 1

Flow diagram showing the recruitment of participants from two Sydney general practices in 2010-12.

While there were no statistically significant differences between intervention and control groups with regards to age, gender, marital status, educational level, household weekly income, country of birth, self-reported health status and skin cancer risk category, there were trends towards higher educational level, higher household income and better health status in the intervention patients than the control patients (TableĀ 1).

Table 1 Descriptive information on the study sample ā€“ Sydney, Australia, 2010

Feasibility

Patientsā€™ participation in the intervention was high, 81% of those invited. At 1Ā month follow up, the response was 86% for the intervention group and 90% for the control group. At 13Ā months, the response was 72% for the intervention group and 68% for the control group. All GPs in both practices participated. Six out of nine GPs from the intervention practice agreed to be interviewed upon completion of the study, the remaining three were on leave at the time of the interviews. Each intervention patient completed the skin cancer risk assessment tool unassisted in 3 to 5Ā minutes. The sun protection advice took 3 to 5Ā minutes. The intervention GPs were able to carry out the intervention within the allotted appointment times (15Ā minutes) and no concern was expressed about the small increase in the consultation time.

Patient acceptability

At 1Ā month 95% of 43 intervention group respondents felt that the skin cancer risk assessment was useful and 98% felt it was easy to understand. Almost two thirds (71%) of the intervention group respondents remembered a discussion with their GP on skin cancer and all of them felt the discussion was useful. Similarly 97% felt the SunSmart UV Alert pamphlet [20] was useful and all felt it was easy to understand.

General practitioner acceptability

All interviewed GPs (nā€‰=ā€‰6) believed they played a useful role in skin cancer prevention. All felt confident in delivering the advice and believed it was beneficial to their patients. All GPs reported the risk assessment tool as easy to understand. Four GPs reported the skin cancer risk assessment tool as useful; one GP said ā€œItā€™s difficult to get GPs to do this intervention on every patientā€ (GP 3), and another ā€œIā€™m not sure whether itā€™s helpfulā€ (GP 5). All GPs reported the SunSmart UV Alert pamphlet [20] as useful, four reported it as easy for the patients to understand, one GP said ā€œIā€™m not sure whether all the patients took them awayā€ (GP 4), and another ā€œThere were not many chances for me to get feedback from the patientā€ (GP 5).

Measures of sun-related knowledge, attitudes and behaviour

Knowledge levels were high at baseline with a mean score of 4.59 in the intervention and 4.16 in the control group out a possible total score of 6. At 1Ā month follow up, the intervention group showed a greater increase in knowledge score (mean differenceā€‰=ā€‰0.48, pā€‰=ā€‰0.034) (TableĀ 2). There were no material differences between groups in sun-related knowledge, attitudes or behaviour at 13Ā months.

Table 2 Sun-related knowledge, attitudes and behaviour at baseline, one and 13Ā month follow up - Sydney, Australia, 2010- 2012

Discussion

A brief skin cancer prevention intervention delivered opportunistically was feasible and acceptable to both intervening GPs and patients. As in previous Australian studies, [34, 35] baseline knowledge levels were high. Relevant sun-related knowledge increased in both groups; and there was a greater short-term increase in relevant knowledge in the intervention group, which was not maintained. There was no evidence of a favourable change in sun-related attitudes or behaviour due to the intervention.

Our study was designed to be delivered opportunistically at a single attendance; other physician-delivered interventions have been more intensive. Robinsonā€™s intervention involved repetitive oral and written skin cancer prevention education with clinical skin examinations at 2Ā weeks and 2, 6, 12Ā months post-surgical excision of a non-melanoma skin cancer [12]. Falk and Andersonā€™s intervention involved a separate 20Ā minute consultation with a single GP who offered oral and written skin cancer prevention education with a clinical skin examination [14]. Rat and colleaguesā€™ melanoma prevention intervention involved a separate consultation with a single GP who offered oral and written skin cancer prevention with a clinical skin examination for patients at high risk of developing primary melanoma [36].

Improvements in sun-related behaviours are difficult to achieve. In Falk and Andersonā€™s study short-term differences in sunbathing and shade seeking behaviour in the group who received sun protection advice from a GP were not maintained [14]. At 3Ā year follow up, significant differences in sun protection behaviour were only seen for sunscreen use in the group who received sun protection advice from a GP compared to the group who received the advice by means of a letter [14]. While our observation of an early effect of the intervention on sun-related knowledge raised the possibility of behaviour change, other evidence indicates that effects of knowledge on attitudes and behaviour are not well understood, and that sun-related attitudes and behaviours are difficult to change [35]. Despite high sun-related knowledge, people often maintain their usual habits [37, 38].

The main strengths of our study were the opportunistic approach, involvement of the patientā€™s usual GP, minimal disruption to the general practice routine and intervention delivery shortly before the Australian summer holidays. Despite the practical difficulties with follow up over summer, the response among the patients was high and all intervention GPs who were contactable agreed to be interviewed. Further, the intervention and control groups were reasonably well matched at baseline.

It was a potential limitation that six different GPs delivered the intervention and may have varied in the ways they delivered it. The study used self-reported outcomes, which are open to various biases; however previous studies show that self-reported sun protection behaviours are well correlated with readings from UV dosimeters and direct observation [39ā€“41]. As a feasibility study, this study was insufficiently powered to observe other than a large effect. Including participants across all skin cancer risk categories may also have reduced the studyā€™s power.

Conclusions

An opportunistic skin cancer prevention intervention is feasible and acceptable within existing primary care arrangements. Evidence of a greater short-term increase in relevant knowledge in the intervention group was not maintained in the longer term. There was no evidence of a favourable change in sun-related attitudes or behaviour due to the intervention; although the study was insufficiently powered to observe other than large effects. The feasibility and acceptability of our approach suggests that further research in this setting, perhaps with strengthened and repeated messages, would be justified.

Abbreviations

GP:

General practitioner

UV:

Ultraviolet radiation.

References

  1. Fransen M, Karahalios A, Sharma N, English DR, Giles GG, Sinclair RD: Non-melanoma skin cancer in Australia. Med J Aust. 2012, 197 (10): 565-568. 10.5694/mja12.10654.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  2. RACGP: Guidelines for Preventive Activities in General Practice. 2012, South Melbourne: The Royal Australian College of General Practitioners, 8

    Google ScholarĀ 

  3. Montague M, Borland R, Sinclair C: Slip! slop! slap! and SunSmart, 1980-2000: skin cancer control and 20 years of population-based campaigning. Health Educ Behav. 2001, 28 (3): 290-305. 10.1177/109019810102800304.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  4. Sinclair C, Foley P: Skin cancer prevention in Australia. Br J Dermatol. 2009, 161: 116-123.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  5. Volkov A, Dobbinson S, Wakefield M, Slevin T: Seven-year trends in sun protection and sunburn among Australian adolescents and adults. Aust N Z J Public Health. 2013, 37 (1): 63-69. 10.1111/1753-6405.12012.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  6. Lin JS, Eder M, Weinmann S: Behavioral counselling to prevent skin cancer:a systematic review for the U.S. preventative services task force. Ann Intern Med. 2011, 154 (3): 190-201.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  7. Moyer VA: Behavioral counseling to prevent skin cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2012, 157 (1): 59-65.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  8. Kreuter MW, Bull FC, Clark EM, Oswald DL: Understanding how people process health information: a comparison of tailored and nontailored weight-loss materials. Health Psychol. 1999, 18 (5): 487-494.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  9. Glanz K, Schoenfeld ER, Steffen A: A randomized trial of tailored skin cancer prevention messages for adults: project SCAPE. Am J Public Health. 2010, 100: 735-741. 10.2105/AJPH.2008.155705.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  10. Manne S, Ming M, Dessureault S, Jacobsen P, Winkel G, Lessin S: Tailored versus generic interventions for skin cancer risk reduction for family members of melanoma patients. Health Psychol. 2010, 29 (6): 583-593.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  11. Glazebrook C, Garrud P, Avery A, Coupland C, Williams H: Impact of a multimedia intervention ā€œSkinsafeā€ on patientsā€™ knowledge and protective behaviors. Prev Med. 2006, 46: 449-454.

    ArticleĀ  Google ScholarĀ 

  12. Robinson JK: Behavior modification obtained by sun protection education coupled with removal of a skin cancer. Arch Dermatol. 1990, 126: 477-481. 10.1001/archderm.1990.01670280061010.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  13. Falk M, Anderson C: Prevention of skin cancer in primary healthcare: an evaluation of three different prevention efforts and the applicability of a phototest. European J Gen Pract. 2008, 14 (2): 68-75. 10.1080/13814780802423430.

    ArticleĀ  Google ScholarĀ 

  14. Falk M, Magnusson H: Sun protection advice mediated by the general practitioner: an effective way to achieve long-term change of behaviour and attitudes related to sun exposure. Scand J Prim Health Care. 2011, 29 (3): 135-143. 10.3109/02813432.2011.580088.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  15. What is General Practice?. [http://www.racgp.org.au/becomingagp/what-is-a-gp/what-is-general-practice/]

  16. AIHW &CA: Non-melanoma Skin Cancer: General Practice Consultations, Hospitalisation and Mortality. Cancer Series No 43 Cat No CAN 39. 2008, Canberra

    Google ScholarĀ 

  17. Health Statistics New South Wales: [http://www.healthstats.nsw.gov.au/Indicator/soc_seifa_lgamap/soc_seifa_lgamap]

  18. Buster KJ, You Z, Fouad M, Elmets C: Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol. 2012, 66 (5): 771-779. 10.1016/j.jaad.2011.05.021.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  19. Hu S, Parmet Y, Allen G, Parker DF, Ma F, Rouhani P, Kirsner RS: Disparity in melanoma: a trend analysis of melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida. Arch Dermatol. 2009, 145 (12): 1369-1374.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  20. Cancer Council Australia: SunSmart UV Alert. 2009, Cancer Council Australia, http://www.cancer.org.au/content/pdf/PreventingCancer/BeSunsmart/SunSmartUValertbrochure.pdf,

    Google ScholarĀ 

  21. Rogers RW: Cognitive and Physiological Processes in Fear Appeals and Attitude Changes: A Revised Theory of Protection Motivation. Social Psychophysiology: A Source Book. 1983, New York: Guilford Press, 153-176.

    Google ScholarĀ 

  22. McClendon BT, Prentice-Dunn S: Reducing skin cancer risk: an intervention based on protection motivation theory. J Health Psychol. 2001, 6 (3): 321-328. 10.1177/135910530100600305.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  23. McMath B, Prentice-Dunn S: Protection motivation theory and skin cancer risk: the role of individual differences in responses to persuasive appeals. J Appl Soc Psychol. 2005, 35 (3): 621-643. 10.1111/j.1559-1816.2005.tb02138.x.

    ArticleĀ  Google ScholarĀ 

  24. Prentice-Dunn S, McMath BF, Cramer RJ: Protection motivation theory and stages of change in sun protective behavior. J Health Psychol. 2009, 14 (2): 297-305. 10.1177/1359105308100214.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  25. Glanz K, Schoenfeld E, Weinstock MA, Layi G, Kidd J, Shigaki DM: Development and reliability of a brief skin cancer risk assessment tool. Cancer Detect Prev. 2003, 27 (4): 311-315. 10.1016/S0361-090X(03)00094-1.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  26. MacKie RM, Freudenberger T, Aitchison TC: Personal risk-factor chart for cutaneous melanoma. Lancet. 1989, 2 (8661): 487-490.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  27. Jackson A, Wilkinson C, Ranger M, Pill R, August P: Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score. Br Med J. 1998, 316: 34-39. 10.1136/bmj.316.7124.34.

    ArticleĀ  CASĀ  Google ScholarĀ 

  28. Feldman SR, Fleischer AB: Skin examinations and skin cancer prevention counseling by US physicians: a long way to go. J Am Acad Dermatol. 2000, 43 (2 Pt 1): 234-237.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  29. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH: A tutorial on pilot studies: the what, why and how. BMC Med Res Meth. 2010, 10: 1-10.1186/1471-2288-10-1.

    ArticleĀ  Google ScholarĀ 

  30. Arain M, Campbell MJ, Cooper CL, Lancaster GA: What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Meth. 2010, 10: 67-10.1186/1471-2288-10-67.

    ArticleĀ  Google ScholarĀ 

  31. 45 and Up Study. [https://www.saxinstitute.org.au/our-work/45-up-study/questionnaires/]

  32. Glanz K, Yaroch AL, Dancel M, Saraiya M, Crane LA, Buller DB, Manne S, Oā€™Riordan DL, Heckman CJ, Hay J, Robinson JK: Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol. 2008, 144 (2): 217-222.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  33. IBM Corporation: IBM SPSS Statistics Premium. 2010, Somers, New York, http://www-01.ibm.com/software/au/analytics/spss/products/statistics/, 190,

    Google ScholarĀ 

  34. Martin RH: Relationship between risk factors, knowledge and preventive behaviour relevant to skin cancer in general practice patients in South Australia. Br J Gen Pract. 1995, 45: 365-367.

    CASĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  35. Stanton JM, Baade P, Anderson P: Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int. 2004, 19: 369-378. 10.1093/heapro/dah310.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  36. Rat C, Quereux G, Riviere C, Clouet S, Senand R, Volteau C, Dreno B, Nguyen JM: Targeted melanoma prevention intervention: a cluster randomized controlled trial. Ann Fam Med. 2014, 12 (1): 21-28. 10.1370/afm.1600.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  37. Arthey S, Clarke VA: Suntanning and sun protection: a review of the psychological literature. Soc Sci Med. 1995, 40: 265-274. 10.1016/0277-9536(94)E0063-X.

    ArticleĀ  CASĀ  PubMedĀ  Google ScholarĀ 

  38. Grunfeld EA: What influences university studentsā€™ intentions to practice safe sun exposure behaviors?. J Adolesc Health. 2004, 35 (6): 486-492.

    PubMedĀ  Google ScholarĀ 

  39. Thieden E, Philipsen P, Wulf H: Compliance and data reliability in sun exposure studies with diaries and personal, electronic UV dosimeters. Photodermatol Photoimmunol Photomed. 2006, 22: 93-99. 10.1111/j.1600-0781.2006.00207.x.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  40. Oā€™Riordan D, Nehl E, Gies P, Bundy L, Burgess K, Davis E, Glanz K: Validity of covering-up sun-protection habits: association of observations and self-report. J Am Acad Dermatol. 2009, 60: 739-744. 10.1016/j.jaad.2008.12.015.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  41. Glanz K, Gies P, Oā€™Riordan D, Elliott T, Nehl E, McCarty F, Davis E: Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure. Cancer Epidemiol Biomarkers Prev. 2010, 19 (12): 3005-3012. 10.1158/1055-9965.EPI-10-0709.

    ArticleĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

Pre-publication history

Download references

Acknowledgements

The authors wish to thank all patients and GPs for their participation and Laura Rodwell for providing statistical support. This study is funded by Australian General Practice Training, the RACGP Foundation and Primary Care Collaborative Cancer Clinical Trials Group (PC4). The study concept was reviewed at a PC4 Concept Development Workshop. The funding sources had no role in the data collection, analysis, interpretation or the writing of this paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kylie Vuong.

Additional information

Competing interests

All authors declare that they have no competing interests.

Authorsā€™ contributions

KV performed the statistical analysis. KV, LT, BB and BKA conceived the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Electronic supplementary material

Authorsā€™ original submitted files for images

Below are the links to the authorsā€™ original submitted files for images.

Authorsā€™ original file for figure 1

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vuong, K., Trevena, L., Bonevski, B. et al. Feasibility of a GP delivered skin cancer prevention intervention in Australia. BMC Fam Pract 15, 137 (2014). https://doi.org/10.1186/1471-2296-15-137

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/1471-2296-15-137

Keywords