Patients’ embarrassment hinders skin cancer screening
MedWire News: Patients' reluctance or embarrassment to undergo a full-body skin examination is one of the major barriers preventing skin screening, according to family practitioners and dermatologists.
Dermatologists, particularly, find this a problem, shows a survey of more than 1600 primary care physicians and dermatologists from the USA.
"A possible reason may be that patients treated by dermatologists present with more stigmatizing problems that are visible on their skin than those presenting to primary care physicians," say researchers Susan Oliveria, from Memorial Sloan-Kettering Cancer Center in New York, USA, and colleagues.
They explain: "Patients may see a dermatologist for an isolated skin condition, such as a wart, and the dermatologist may feel awkward asking this person to undress for a full-body skin examination.
"Conversely, internists and primary care providers routinely ask patients to undress for physical examinations, such as pelvic and rectal examinations; thus, undressing for the examination is understood and expected."
The researchers also suggest in the Archives of Dermatology that patients may be less self-conscious with their primary care physician than with a specialist because they have built up a stronger relationship with the former over time.
Commenting on the findings, Amit Garg and Alan Geller, from Boston University School of Medicine in Massachusetts, USA, suggested that "adding office-based information on the importance of physician-directed skin examination may mitigate patient embarrassment and reluctance to undress."
They added: "Patients initially declining an opportunity for a full-body skin examination should be approached by trained staff who explain the relevance of a skin cancer screening, address any additional expressed concerns, and make a second effort for a full-body skin examination."
The survey findings showed that, overall, 81% of dermatologists and 60% of primary care physicians performed full-body skin examinations on their patients during a complete physical examination. However, more than three in 10 primary care physicians and one in 10 dermatologists reported not screening more than 76% of high-risk patients - those with family history of skin cancer, suspicious moles, fair skin and a high and poor sun exposure history.
Other barriers cited by the primary care physicians and dermatologists for not carrying out skin cancer screening were time constraints and the need to deal with other health conditions.
"Understanding the determinants of patient skin cancer screening could help promote interventions based on physician characteristics that are amenable to change, potentially improve physicians' prevention practices, and help promote early detection," Oliveria and colleagues conclude.
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By Lucy Piper