Skin cancer is the most common malignancy in the United States (ACS, 2008). As the US population of adults 65 and older increases by an estimated 20 percent in the next decade, the incidence of and mortality from skin cancer will rise (Wier et al., 2003). Despite the use of educational efforts by physicians to promote the use of sun protective behaviors among their patients, studies continue to document the widespread rates of intentional sun exposure and low sun protection. These reports suggest that there remains a need to improve the impact of physician (MD) delivered skin cancer prevention. Brief Negotiation Interview interventions (BNIs) (e.g., Rollnick et al., 1997) have been shown to be efficacious in modifying health- related behaviors that are extremely resistant to change (e.g. smoking) and may be a promising approach to use in lowering UV risk behaviors, thus warranting further examination. The objective of this etiological research is to train MDs to deliver a BNI intervention to their patients in the context of a routine office visit. The primary aim of the study is to fully develop a sustainable BNI training program focused on UVL risk and protective behaviors for MDs and evaluate whether MDs can be trained to deliver the BNI to patients with fidelity. Approximately 10 dermatologists will be recruited to the study. All MDs will be observed interacting with patients prior to receiving the BNI training to assess baseline MD-patient communication during a routine office visit. Following the baseline assessments, MDs will receive the BNI training, additional supervision, and be assessed for ability to deliver the BNI with fidelity. If the study determines MDs are able to deliver the BNI to patients with fidelity, future studies will examine the impact of the BNI intervention on patients with regard to UVL risk and protective behaviors. The present study explores the ability of physicians to be trained to deliver a behavioral intervention in the context of naturally occurring patient interactions and shows promise for long term sustainability.
The incidence of invasive skin cancers, cutaneous melanoma in particular, has nearly tripled in the U.S. between 1975 and 2004, making it the fastest rising incidence rate for all cancers in the United States. Physicians are in an ideal position to effect change in their patients. The present study will assess whether dermatologists can be sustainably trained to deliver a brief motivational behavioral intervention to patients with fidelity during the context of a 15-minute office visit.
