Overcoming Obstacles to Skin Cancer Examinations and Prevention Counseling for High-Risk Patients: Results of a National Survey of Primary Care Physicians

Article Figures & Data

Table 1.

Percentage of Physicians (n = 380) Routinely* Performing Skin Cancer Screening and Prevention for Average-Risk and High-Risk Patients

	Average-Risk Patients	High-Risk Patients^†
Screening
Full-body examinations^‡	32%	59%
Counseling Recommendations
Recommend skin self-exam	24%	58%
Recommend regular sun protection	33%	68%
Recommend avoidance of tanning booths	50%	68%

* Routinely defined as performing the practice with ≥76% of patients.
† High-risk patients include those with fair skin, many moles, a few atypical moles, family and/or personal history of skin cancer, and excessive sun exposure.
‡ All counseling and screening differences between average and high-risk patients, P < .05.

Table 2.

Skin Cancer Examinations and Counseling for High-Risk Patients by Physician Attitudes

	Perform Full-Body Exams		Recommend Skin Self-Exam
	Yes	No	Yes	No
Belief in the effectiveness of physician skin exam
Very effective (n = 169)	65%	35%	67%	33%
Somewhat/Not at all effective (n = 211)	54%	46%	52%	48%
χ²	4.0^*		8.1^*
Confidence in ability to identify suspect lesions
Very confident (n = 145)	75%	25%	67%	33%
Somewhat/Not at all confident(n = 234)	48%	52%	53%	47%
χ²	24.3^†		7.1^*

* P < .05.
† P < .001.
χ² refers to the comparison between performance and recommendations among physicians with and without reported attitude.

Table 3.

Skin Cancer Examinations and Prevention Recommendations for High-Risk Patients by Physician Obstacles for Performance (n = 380)

Physician Obstacles	Physicians Who Perform Full-Body Exams		Physicians Who Recommend
	Physicians Who Perform Full-Body Exams		Skin Self Exam		Sun Protection		Tanning Bed Avoidance
	%	χ²	%	χ²	%	χ²	%	χ²
Lack of time		14.6^†		4.3^*		2.9		0.2
Yes (n = 265)	52		55		65		68
No (n = 115)	75		67		74		70
Lack of training		10.4^†		9.7^*		17.1^†		12.4^*
Yes (n = 57)	39		39		44		48
No (n = 323)	62		62		72		72
Co-morbidities		9.2^*		1.5		0.7		1.2
Yes (n = 129)	47		54		65		64
No (n = 251)	65		60		69		70
Patient reluctance		2.0		10.8^†		0.2		0.3
Yes (n = 134)	64		70		69		70
No (n = 246)	56		52		67		67
Lack of reimbursement		10.7^†		1.8		5.8^*		0.1
Yes (n = 71)	41		51		55		67
No (n = 309)	63		60		71		69