Nursing intervention and promoting self-examination

Evidence suggests primary care nurses can reduce cancer risk by promoting early detection/ referral (Austoker, 1994; Taylor and Roberts, 1997; Oliveria et al., 2002). Nurses are a substantial health education resource (Bradford and Winn, 1997; Latter et al., 2000; Runciman et al., 2006). Studies of nurse-led interventions to increase cancer awareness or change behaviour have been successful (e.g. Koinberg et al., 2004; Sharp and Tischelman, 2005). However, most initiatives have not been applied to skin cancer prevention, involve self-examination only (e.g. Oliveria et al., 2002), have a limited theory base and do not evaluate education to reduce risk behaviour (Oliveria et al., 2004).

A systematic review by Saraiya et al. (2004) argues for research focused on health outcome, patient behaviour and the ‘role of the non-physician provider to help identify if counselling skills to change behaviour might be better suited to providers with the time and skills, such as a nurse’ (p. 444); however, there is little evidence of such studies. Also, resource-efficient models of service delivery are required for primary care. Nurses can effectively increase self-efficacy in targeted patient telephone interventions (Wong et al., 2005) with review evidence finding these safe and acceptable (Bunn et al., 2004).

This section focuses on self-examination for primary disease; however, it also embraces selfexamination for metastatic disease. The literature primarily focuses on the former, not the latter. Since primary and secondary prevention are key nursing roles, these are covered in some detail.

Do patients perform self-examination correctly?
Patients’ ability to perform self-examination correctly has not been assessed previously. The UK national guidelines (Roberts et al., 2002) do not clearly specify what would constitute a competent SSE. Specific body sites should be examined and there is a need to search for both metastatic disease and other primary melanomas should be.

For competence to be achieved, an individual must possess the appropriate knowledge and skills, be confident to perform the skill safely and trust their own ability to perform the skill without direct supervision. Elements were taken from the definition of competence used by Roach (1992). Whilst it is purported that females in the general population are more knowledgeable about melanoma then men (Bourke et al., 1995; Miller et al., 1996; Melia et al., 2000), the only insight pertaining to the level of knowledge possessed by patients actually diagnosed with melanoma comes from a small retrospective study by Regan et al. (1995). Here, patients ‘did not clearly know why the examination was being performed or what was being searched for’ (p. 13) during self- examination even after regularly submitting to the clinical examination at follow-up. However, if metastases were detected, patients did recognise the importance of their find and reported it: 50% contacted their GP; 28% contacted the hospital; but 22% waited for the next outpatient appointment. Knowledge of skin changes and abnormalities has been found to reduce individuals delay in seeking medical attention for melanoma (Oliveria et al., 1999a). Confidence to carry out SSE for primary skin lesions has been found to be poor (Carli et al., 2002). It is not known how confident individuals diagnosed with melanoma feel to perform self-examination or to detect metastatic disease. The level of trust placed in the hospital health professional and in themselves to perform selfexamination is also not known. From the limited literature available on patient’s knowledge, confidence and trust, it is impossible to conclude if patients are able to perform self-examination correctly.