ABSTRACT
Purpose: The purpose of this study was to better understand what behaviors, attitudes, and knowledge nurse practitioners (NPs) working in primary care have on the topic of skin cancer screening and prevention.
Background: Skin cancer is currently the most commonly diagnosed cancer in the United States, and the prevalence of skin cancer diagnoses continues to rise. Currently, melanoma stands alone as the most commonly diagnosed malignancy among those aged 25-29 years (American Academy of Dermatology, 2012), and the incidence of malignant neoplasms of the skin is higher than any other cancer malignancy tracked by the Centers for Disease Control (Rager, 2005). As researchers continue to try to determine the reason behind the increase in skin cancer diagnosis, numerous environmental and genetic factors have been identified. Most interventions for this problem have thus far been knowledge based, utilizing numerous mediums (print, video, face-to-face survey) in various environments (school, community, and physician-office based) with varying degrees of efficacy. Primary care providers (PCPs) are uniquely positioned to provide the type of knowledge-based counseling needed to reduce risky sun exposures among this population, yet counseling about safe sun exposures is among the lowest reported counseling topics discussed at PCP visits (Jun, 2005).
Methods: This capstone project is a needs assessment reviewing attitudes, behaviors, confidence, and knowledge among primary care NP providers. This was gauged via 29-question multiple-choice online survey adapted from Mikkilineni's survey of PCP offices in 2001 (Mikkilineni, 2001). Six hundred thirty-four emails were sent, and of those, 240 were opened by participants. Of those 240, 91 responded, affording the study a 37% response rate.
Results: More than half (55%) of respondents state that they did not perform a skin examination during an initial physical on a new patient in the past month, and only 29% report performing skin examinations during annual visits. More than half (65%) state that they never or only sometimes provide patients with counseling on skin-cancer-related topics. Overall, respondees felt that counseling was important, and 90% stated that PCPs can be effective at helping their patients detect skin cancer early. However, less than half (44%) feel that patients want to be counseled on the topic. Only 1% of respondents considered his or her knowledge of skin cancer at the "expert" level, and almost half (43%) felt their knowledge was basic to minimal. Most of the respondees (81%) reported having no training in the past year related to skin cancer. Forty-one percent of the respondees report only mild to no confidence in their ability to perform skin examinations.
Conclusions: Survey results indicate that NPs understand the importance of screening for skin cancer as well as counseling on the topic with their patients but feel unprepared to do so. Further studies are needed to more effectively gauge NP knowledge in this area, and it is of highest importance that ongoing education is regularly provided on to further reduce the steadily climbing rates of skin cancer in the United States.