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Effectiveness of interventions to support the early detection of skin cancer through skin self‐examination: a systematic review and meta‐analysis
Author(s) -
Ersser S.J.,
Effah A.,
Dyson J.,
Kellar I.,
Thomas S.,
McNichol E.,
Caperon E.,
Hewitt C.,
MuinMartin A.J.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17529
Subject(s) - medicine , psychological intervention , psycinfo , medline , systematic review , observational study , meta analysis , randomized controlled trial , odds ratio , confidence interval , family medicine , surgery , nursing , political science , law
Summary Background As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self‐examination ( SSE ); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. Objectives To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. Methods This is a systematic review (narrative synthesis and meta‐analysis) examining randomized controlled trials ( RCT s) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE , Embase and Psyc INFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE ). Risk‐of‐bias assessment was conducted. Results Included studies ( n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCT s and five quasiexperiments and one complex‐intervention development. More studies ( n = 10) focused on targeting high‐risk groups (surveillance) than those at no higher risk (screening) ( n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self‐reported, behaviour related and nonclinical in nature. Meta‐analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90–2·82), but with small effect sizes. Risk‐of‐bias assessment indicated that 61% of the studies ( n = 11) were of weak quality. Conclusions Four RCT s and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality.