Adhering to Patient Preferences Improves Patient Comfort During Skin Cancer Screening
To improve patient comfort during full-body skin cancer screenings, dermatologists should respect patients' preferences for the gender of the examining clinician and for how the genital area is examined.1
Approximately 20% of people will develop skin cancer during their lifetime. Melanoma accounts for less than 1% of all skin cancers but comprises the overwhelming majority of deaths from skin cancer. The rates of melanoma have tripled over the previous 40 years.
Sun protection and regular self-examination are important pieces of skin cancer detection. People at increased risk of developing skin cancer should be screened by a dermatologist annually.
"This study identifies barriers to getting skin checks. Giving patients choices that reduce embarrassment during an exam may make a person more likely to get regular skin checks, leading to higher rates of skin cancer detection," said Laura Ferris, MD, PhD, associate professor, Department of Dermatology, Pitt School of Medicine and member of the Melanoma Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, and lead author of the study.
This study, published in JAMA Dermatology, scientifically examined whether Ferris's observation that patients preferred clinicians the same gender as the patient could be used to improve patient comfort. Researchers at 3 different institutions sent an anonymous survey to 443 adults receiving full-body screening for skin cancer.
Of the respondents, one-third of women and almost one-fifth of men expressed a gender preference. Almost all women (99%) who expressed a gender preference would prefer a woman, and nearly two-thirds of men with a preference would prefer a man to administer the screening.
Women younger than 30 years were more likely to prefer a female physician. Since the population of women younger than 30 years experiences a quickly growing rate of melanoma, accounting for gender preference could remove barriers to full body skin screening.
Almost half of women and 40% of men preferred to wear undergarments rather than disrobe completely. Some of the women (31%) and men (13%) preferred not to have their genitals examined at all. Less than 1% of melanomas are found in the genital region.
"When we think about the relative risks and benefits of cancer screening, if we're causing people discomfort, then we need to think of that as doing harm. Our study provides some easy ways to reduce that harm," Ferris said.
"In the age of personalized medicine, taking simple steps, such as offering a choice of physician gender and degree of disrobement during an examination, can allow us to personalize the skin cancer screening examination to minimize discomfort."
1. Houston NA, Secrest AM, Harris RJ, et al. Patient preferences during skin cancer screening examination [published online ahead of print May 11, 2016]. JAMA Dermatol. doi:10.1001/jamadermatol.2016.1005.