The goal of this proposal is to develop and evaluate a sun protection educational intervention for kidney transplant recipients (KTRs) to prevent skin cancer. Kidney transplantation is the treatment of choice for patients with end-stage renal disease, however, the requisite life-long immunosuppressive therapy is associated with developing skin cancer, especially squamous cell carcinoma (SCC). SCC afflicts 19% of KTRs between 3-8 years post-transplant,10-45% by 10 years, and 61% by 20 years. Some KTRs develop more than 100 skin cancers in 1 year. Among the approximately living 100,000 KTRs in the United States, many suffer impaired quality of life from disfigurement of surgical removal, anxiety and fear about the return or spread of the cancer, and concern about the reaction of others. Education about the importance of sun protection is necessary for all KTRs, including minorities who comprise 38% of living KTRs. Focus groups convened by the National Kidney Foundation indicate that clinicians rarely provide education after transplantation about skin cancer risk and prevention, nor do clinicians educate patients effectively enough to promote sun protective behaviors. Recipients'perceived importance of SCC and personal risk of developing SCC moderate an individual's sun protection behavior, e.g. applying sunscreen, seeking shade, and avoiding deliberate tanning. Darker-skinned individuals may perceive themselves as either at low or no risk for skin cancer given their limited personal experience with sunburns, and limited public education efforts focused on minorities. Our KTR focus group research examined the optimal time and format for sun protection education. KTRs recommended providing sun protection education before the first summer after transplantation and desired a booklet that can be reviewed with their health care provider and taken home to read with family. The proposed pilot study extends our research by developing and evaluating culturally sensitive, printed sun protection educational materials for KTRs. We will evaluate the effectiveness of educational materials in changing sun protection behavior with an intervention phase that randomizes equal numbers of non-Hispanic White, Hispanic and Black KTRs to the intervention and customary care, and evaluates outcome measures at 3 and 6 months in comparison to baseline measures. By developing educational materials that effectively increase sun protection behaviors, we will be well poised to develop an interactive web-based system to disseminate the material to KTRs. Future research will assess optimal approaches to disseminating a sun protection program to US transplant centers by print or web-based delivery.

Public Health Relevance

The almost 100,000 living kidney transplant recipients with functioning grafts in the United States are estimated to have a 65-fold increased incidence of skin cancer, squamous cell carcinoma, caused by sun exposure. Sun protection counseling is not performed when KTRs are ready to implement the behavior nor is sufficient information provided to implement the behavior. The research will develop and evaluate a new culturally sensitive approach to sun protection counseling to prevent skin cancer which can be disseminated to all living kidney transplant recipients during the first year and subsequent years after transplantation.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Patrick, Heather A
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Northwestern University at Chicago
Schools of Medicine
United States
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Guevara, Yanina; Gaber, Rikki; Clayman, Marla L et al. (2015) Sun protection education for diverse audiences: need for skin cancer pictures. J Cancer Educ 30:187-9
Robinson, J K; Guevara, Y; Gaber, R et al. (2014) Efficacy of a sun protection workbook for kidney transplant recipients: a randomized controlled trial of a culturally sensitive educational intervention. Am J Transplant 14:2821-9