Why are GPs not using dermoscopy?

Talk Code: 
6C.4c
Presenter: 
Nigel Hart
Twitter: 
Co-authors: 
Fee J, Finbar P. McGrady, Nigel D. Hart
Author institutions: 
Queen's University Belfast

Problem

Cases and deaths from melanoma, the UK’s fifth commonest cancer, continue to rise in many countries. Successfully managing melanoma necessitates its early detection. Most patients with concerning pigmented skin lesions (PSLs) present first to their General Practitioner (GP).

Visual inspection of PSLs has limited accuracy because many early melanomas can mimic benign lesions, and many benign lesions can change in appearance, mimicking melanomas. For GPs, deciding whether to refer or reassure patients is therefore very difficult. GPs’ referrals to specialist services for suspected skin cancer have risen enormously in recent years.

Dermoscopy is a relatively new tool for assessing PSLs, and has been shown to improve trained GPs’ abilities to triage lesions suggestive of skin cancer. However, dermoscopy is currently used by a small minority of GPs globally. There have been calls for dermoscopy to become a standard clinical tool for GPs similar to a stethoscope.

Work to understand GPs’ perceptions of dermoscopy and possible barriers to its use has been undertaken previously in questionnaire studies, but published work has not explored influencing factors in-depth.

Thus study aimed to explore factors that influence GPs’ use of dermoscopy in primary care.

Approach

A qualitative study design was chosen with the study methodology underpinned by principles of grounded theory including an iterative study design, purposive sampling, constant comparison and theoretical sufficiency. GPs registered on a social media platform for GPs in Northern Ireland (representing approximately one-third of Northern Ireland GPs) were invited to participate. Information was gathered on respondents’ dermoscopy experience, and a purposive sample was taken to explore the perceptions of 1. established dermoscopy users; 2. new dermoscopy users; and 3. dermoscopy non-users. A number of additional participants were recruited through a ‘snowballing’ approach. Twelve semi-structured interviews lasting approximately 20-30 minutes were conducted by JF, recorded and transcribed verbatim. Data coding was facilitated using NVivo software. The data were analysed using a thematic analysis (Braun & Clarke).

Findings

Key themes that have been generated from the data include:

1. Need for training and certification;

2. Importance of accurate diagnosis;

3. Impact on personal clinical practice;

4. Clinical and personal priorities;

5. Confidence;

6. Adapting to innovation;

7. Interactions with secondary care.

Consequences

This study has revealed several factors that influence dermoscopy use among GPs, many of which may be modifiable. Current short training programmes are often considered inadequate to give GPs the skills and confidence needed to use dermoscopy in practice. Agreed standards for dermoscopy training and use in practice could help to guide training and development and safeguard patient care. Collaborations between primary and secondary care could help to streamline referrals using dermoscopy. Given the rising burden of skin cancers, equipping GPs to assess skin lesions more accurately must be considered a priority.

Submitted by: 
Jonathan Fee
Funding acknowledgement: 
JF’s study fees and maintenance come from HSC R&D Division, Public Health Agency’s GP Academic Research Training Scheme and EAT/5336/17.