Twenty-two telephone interviews ranging in duration from 10 to 45 minutes were completed and transcribed. The demographics of participating interviewees are summarised in Table 1. Six main themes emerged during coding: skin checking behaviour; friends and family; other health professionals; ideas around technology; ‘nuts and bolts’- practical experience of the ASICA trial; and finally, ASICA: the app impact, design and usability. See Supplementary File S2 for full Framework, themes and subthemes.
Skin Checking Behaviour
How participants in both groups checked their skin during the ASICA trial
More than three quarters of participants interviewed stated that they examined their skin regularly. Of those who did not, only one was from the ASICA intervention group. Five individuals (three men and two women) reported not checking their skin regularly and it appeared that living alone was a potentially determining factor, not having someone to encourage, remind and help them check awkward or difficult to see areas of the body. Individuals living alone tended to await their regular hospital follow-up appointments feeling that these were sufficient for monitoring their condition. Those who did check their skin regularly mentioned a variety of approaches. The most common method was having an unstructured look over or “quick check”- (F, 48, Control). This idea ran through most interviews with participants stating it was part of daily routine to “keep an eye” on things (F, 49 control).
Almost 90% of the intervention group stated that they used ASICA to aid skin checking, and most reported following the instructions provided which were designed to facilitate a high-quality skin examination.. Two participants in the intervention group stated they no longer used the app to check skin, however one described using what it had taught them initially to continue skin checking using alternative technology. See Table 2.1 for full quote.
Table 2.1
How participants reported checking their skin
Analysis overview
|
Quote
|
Participant
|
Unstructured skin checking
|
“I mean I do keep an eye on it, I don’t know if you would class it as examining”
|
11048, Female, 48, Control
|
“I have a quick check to see there’s no other strange things happening and there isn’t.”
|
11024, Male, 76, Control
|
Skin checking with ASICA app
|
“I just follow it to the app”
|
12048, Male, 60, Intervention
|
“Well I use the app, just look at the pictures and then look at the, look at the bits on my, bits on my skin, I usually get my husband to look at my back, backs of my legs and down my back and that”
|
11054, Female, 47, Intervention
|
Use of other technology instead of ASICA
|
“the ipad is quite good at taking pictures close up as well, so that’s what we used, I find it a lot easier [than the study tablet], and it moves a lot easier to touch”
|
11060, Male, 54, Intervention
|
Perceived thoroughness of skin checking
|
“I don’t do is what they suggest you should do which is a thorough check in every sort of area and, and crack and orifice and under your boobs and wherever else. So, oh I don’t, I don’t do that particularly thoroughly”
|
11014, Female, 49, Control
|
“I’m not very rigorous about it”
|
12008, Female, 39, Control
|
When participants checked their skin
Although there were variations in how people checked their skin, the contexts which checks were conducted in were remarkably consistent. Almost all mentioned checking their skin when they showered, with washing being a near universal prompt. The app users stated that the monthly reminders were a useful prompt to remember to perform a structured skin check. It was not only the intervention group who mentioned the trial triggering them to check skin: a participant in the control group stated that taking part in the trial had influenced her to change her perceptions and personal practice with respect to skin checking. See Table 2.2 for further evidence on when skin checking occurred.
It was generally apparent from interviews that skin checking was widely occurring and valued, and that the thoroughness and effectiveness of checking varied between individuals, among both in those using and not randomised to receive the intervention. However ASICA users appeared more likely to make a conscious effort to check their skin regularly and in a structured way, and around a third stated that they had communicated a concern to the study Clinical Nurse Specialist about using the app. Notably, two participants in the control group reported having used technology to digitally enhance their own skin checking and were tracking areas of concern with photos stored on their mobile phones. See Table 2.1 for further detail on how participants checked their skin.
Table 2.2
When participants checked their skin
Analysis overview
|
Quote
|
Participant
|
Showering as a trigger for skin checking
|
“If I’ve had a shower or whatever, I’ll sort of look, does that look different, or does it not”
|
11054, female, 47, Intervention
|
“very general check every day, I would say, cause I’m showering every day.”
|
11014, female, 49, Control
|
App reminder to perform skin checking
|
“every month I get a reminder to, to go over it on the app and check from top to toe”
|
11062, male, 61, Intervention
|
Trial participation- influence on skin checking
|
“the questionnaire probably acted as a reminder for me to do a little bit more,”
|
11014, female, 49, Control
|
Knowledge and skills required to perform a skin check
While all intervention group participants had received training in how to perform a total skin self-examination as part of the intervention, reports of having receiving training to conduct TSSE in the past as part of usual care varied between individuals and study sites. Overall, four of six Cambridge participants reported having received TSSE training, whereas only three of 14 Grampian participants had received TSSE training. Some participants had skin checking explained and demonstrated to them by a specialist. Just under a quarter of participants reported having received a leaflet explaining TSSE, while several participants reported no knowledge or education about TSSE. See Table 2.3 for quotes on participant experience.
Table 2.3
Quotes reflecting participants’ knowledge and skills about skin checking
Analysis overview
|
Quote
|
Participant
|
Specialist explanation of skin checking
|
“the doctor had told me, or the consultant told me to look for, you know, like changes in shape or symmetry or colour, or text, you know, if it got raised or just that sort of thing, looking for any changes, or anything new, that wasn’t there before.”
|
11054, female, 47, Intervention
|
“fairly good instructions, and usually from the nurses more than the doctors, but on the skin checks I’ve had through the NHS, they, they’ve been quite good in terms of tutorials, so I’m quite happy in terms of what I’m looking at”
|
12008, female, 39, Control
|
“was shown how to do the groin,”
|
11013, female, 73, Intervention
|
Leaflet instruction for skin checking
|
“I’ll just have a look, but no, never been told, whatever the, never been verbally told, there was a leaflet sometime back”
|
11040, male, 51, Control
|
Self-taught skin checking
|
“I haven’t been taught by anybody. I’ve been doing it for so long, I just know”
|
11012, male 49, Control
|
Table 2.4
Quotes reflecting participants’ beliefs about skin checking
Analysis overview
|
Quote
|
Participant
|
Skin checking requires input of another person
|
“you can’t go and check your own back and stuff, so, so you would need to then have the help of someone else,”
|
11052, female, 48, Control
|
“Hundreds of moles on my skin, so it’s not easy to monitor them all together, so that’s why I just prefer to speak with the, some kind of professionals, someone like a dermatologist, than just checking myself,”
|
11018, male 39, Intervention
|
Dismissive attitude to skin checking
|
“how do you learn to check your skin, you just look! -11017
|
11017, female, 76, Control
|
Change in attitude to skin checking following app use
|
“I would just say you’re, you’re far more aware of it, checking your skin and stuff now as what you ever, maybe more so now, than what I was previous”
|
11060, male, 54, Intervention
|
Beliefs about skin checking
Data on the practice and value of skin checking provided a diverse range of responses from participants with some distinctive threads running through the interviews. Living alone appeared to be the most influential demographic factor, with a practical point being raised that skin checking was very difficult to perform alone, and that help was needed from others to perform it properly. Similarly, participants with many visible moles on their skin reported finding it difficult to adequately monitor them all, preferring a professional to check for changes. The role of others also emerges in a subsequent theme.
The value people placed on skin checking varied between individuals, but some dismissed its value and it appeared to be rarely considered as an active health improvement practice. The relationship between previous melanoma and current health did not appear to be acutely perceived, only one participant mentioning their previous melanoma when asked about their general health. Some participants’ opinions on beliefs about skin checking appeared to change after using the ASICA app. See Table 2.4 for further details. Overall, for members of the intervention group, using the ASICA app appeared to increase positive attitudes toward and frequency of practice of TSSE.
Feelings about skin checking
While it was possible that frequent skin checking could function to increase or heighten worries about melanoma recurrence, there was little evidence within the transcripts that feelings and emotional responses to skin checking were especially powerful. For most, it appeared to be a straightforward and non-emotive practice. Of those who did, some respondents in both the intervention and control groups expressed a lack of confidence in their own ability to correctly self-check and to identify changes which may be indicative of recurrence, suggesting that they saw this as a health professional’s role. This view tended to be expressed more by younger respondents. One intervention group participant suggested that before using ASICA, their skin-checking had been an ad-hoc activity to reassure themselves when they became worried about something. Another intervention participant implied that ASICA worked well for them, but only because they were already confident in their ability to skin check. None of the participants stated they felt the need to use the tablet provided for skin checking more regularly than once a month. See Table 2.5 below for further details.
Table 2.5
Quotes reflecting participants’ feelings about skin checking
Analysis overview
|
Quote
|
Participant
|
Lack of confidence in skin checking ability
|
“My concern is that the... that was the mole that I was least concerned about so that, does that makes sense?”
|
11014, female 49, Control
|
“I feel more happier if there’s someone told me that, you know, everything is right with my skin, and that’s the words coming from the specialist, and not me after checking my skin on the app, so you know.”
|
11018, male, 39, Intervention
|
Use of skin checking as reassurance
|
[before starting using the ASICA app] “I just kind of tended to keep an eye on things generally, you know, without kind of saying, oh I must do it this week or whatever, I just do it whenever, whenever it came to mind, but quite often I would say, because I was kind of worried about it.”
|
11054, female, 47, Intervention
|
Family and friends’ input into skin checking
As outlined above, one of the perceived difficulties with skin checking was that it was difficult to do thoroughly alone. Not all participants received regular help with skin checking, although around three quarters did. Views on the absolute necessity of having assistance varied. Two participants perceived themselves as being unable to complete effective TSSE, particularly when checking their back, without the support of another. In contrast, another two mentioned completing it alone (e.g. using a mirror) and one saw no barrier to other people doing the same. Clearly, individual experiences, circumstances and capabilities were influential in determining attitudes towards this aspect of skin checking. See Table 3 for further detail.
Table 3
Quotes reflecting participants’ views on family’s input into skin checking
Analysis overview
|
Quote
|
Participant
|
Input of family to skin checking
|
“the bit I can’t see is my back, so my husband checks that for me regularly”
|
12035, female, 53, Intervention
|
Beliefs about skin checking without help
|
“you definitely can’t do it if you’re on your own, obviously, you definite, you need someone”
|
11052, female, 48, Intervention
|
Negative experience of skin checking alone
|
“I find it extremely difficult because I live in a small house, by myself,”
|
11016, male, 86, Intervention
|
“I find quite difficult, well I, well I sometimes don’t get that all done actually, when I’m on my own, no.“
|
11013, female 73, Intervention
|
Positive experience of skin checking alone
|
“the biggest problem is the checking the physical checking of awkward bits. But, I mean that’s really nae the fault of the app but… I would think most people should manage okay.”
|
11062, male 61, Intervention
|
“the most difficult is the scalp, because you obviously can’t see that, so but I’ve got short hair, so it’s not too bad, the rest you can pretty much do yourself, with a mirror.”
|
11022, female, 62, Intervention
|
Input of health professionals outside the ASICA trial
The involvement of health care professionals outside of the trial varied by the demographic and health status of interviewees. Some had been attending scheduled melanoma follow-up appointments in hospital during the study period, others had completed follow-up and had seen only their GP as required, while some had received no health professional contact at all. Participants generally perceived difficulties and barriers to obtaining appointments for their skin in both primary and secondary care. Two interviewees discussed having a lack of confidence in their GP’s expertise on skin and corresponding ability to reassure them when concerns arose. Overall, however, around half reported that they were highly satisfied with the care that they were receiving. Around a quarter of participants expressed a preference to receive specialist care rather than care from a GP. See Table 4 below for examples.
Table 4
Quotes reflecting the role of health professionals in participants’ skin monitoring
Analysis overview
|
Quote
|
Participant
|
Variation in input from/contact with health professionals
|
“I’ve got a dermatology appointment and I’ve got a plastic’s appointment, so it’s like run every 3-monthly”
|
11052, female, 48, Intervention
|
“they’re remarkably busy as, as you would expect and so I was discharged from dermatology and advised that if I had any concerns that I would, should see my GP.”
|
11014, female, 49, Control
|
Issues around appointments for skin health care
|
“she had to refer me to a GP which, and she, and I had to wait three weeks to see the GP.”
|
11013, female, 73, Intervention
|
“it’s a week, ten days extra worrying before you find out what it really is and then, going from there, and then by the time you get an appointment for, the scan or whatever, it can, can be months”
|
11062, male, 61, Intervention
|
“was told yeah, I’d be getting a 6 monthly checks for the next 5 years, so I think I had, I’m not sure, it was either, I think after the initial assessment, it was either 2, possibly 3, certainly no more than 3, and then there was never any contact made again“
|
11040, male, 51, Control
|
Confidence in care
|
“I’m not even always confident that my GP knows what they’re looking for…”
|
11014, female, 49, Control
|
“I think this is new, the GP wouldn’t have an idea whether it was new or wasn’t new.”
|
11022, female, 62, Intervention
|
Positive feedback on care
|
“I absolutely cannot ever fault my care, I’ve been so well looked after, yeah, no totally, very, very well supported.”
|
11052, female, 48, Intervention
|
Preference of health care professional
|
“prefer to speak with the, some kind of professionals, someone like a dermatologist, than just checking myself, because you know, if you see your, your body on a daily basis, it’s difficult notice that any changes or something is going on, especially on the back of my body”
|
11018, male, 39, Intervention
|
“my GP was very dismissive of my mole, and so I probably, if I was still under the care of the dermatology, I would elect to go direct to, to dermatology…………”
|
11048, Female, 48, Control
|
Ideas around technology
The sample were relatively experienced in using technology, with over three quarters of participants saying that they used digital devices and apps every day. Most older participants were already familiar with technology and did not perceive a particular it as a barrier to participation since they reported receiving good training at the start of the study. Two participants who were not as keen on using technology in healthcare were from the control group, both female, rurally–based and over 70. Both appeared relaxed about their skin and viewed ongoing structured skin-checking and follow-up as potentially burdensome and stressful.
Use of other skin checking apps was rare, and most participants were unaware of their existence. One participant in the control group had used another skin checking app, but found it ineffective, however, using ASICA intrigued them. See Table 5 below for full quote. Previous experience of using digital technology specifically for healthcare was limited within the sample, but there was a general agreement that technology offered promise for more efficient care in the future. One described ASICA as “like a real innovation” (11018, male, 39, Intervention).
Table 5
Participant experience with and beliefs about technology
Analysis overview
|
Quote
|
Participant
|
Use of apps
|
“Oh gosh, daily, many, many times a day.”
|
11048, female, 48, Control
|
“I don’t know, I don’t know if it’s an app or not. Well I mean, I’ve got two apps on my phone today. One of which works and one doesn’t yet.”
|
11017, female, 76, Control
|
“If they are, they’d have been downloaded by my wife, she’s the expert!”
|
11024, male, 76, Control
|
Previous experience of health and skin apps
|
“did download something [app to check skin], but it was, it was next to useless,”
“was hoping to be randomised into the group with, with the technology, just because I was interested to, you know, to see what, what that would have been like”
|
11048, female, 48, Control
|
“when I was in hospital the doctor gave me an app, what was it called? Squeezy! Squeezy, or it’s called or something. Sort of, pelvic floor exercises.”
|
12012, female, 62, Control
|
“Do they, do they actually exist or?”
|
11017, female, 76, Control
|
Beliefs about use of technology in health care
|
"we use mobile technology and phones and apps so much these days, I think it’s the way to go."
“It prevents you sort of wasting the GP’s time.”
|
11022, female, 62, Intervention
|
"I don’t rely….on the ASICA thing to actually keep me … up to date, if I’ve got a, really concern, I would contact the hospital”
“think it’s nice as a backup, but when it comes to actually examining moles that could be cancerous I think that still needs to be done by [specialist], when they check me, they’re using a specialist eye glass,”
|
12035, female, 53, Intervention
|
Beliefs about confidentiality
|
"I’d be more concerned if they hacked into my bank account than into my health."
|
11022, female, 62, Intervention
|
“I wouldn’t want any images being stored and easily accessible on my device, so happy if it’s all kind of encrypted and locked away by passwords, so that would be a big deal for me in terms of where any data was stored …. no problem with it being uploaded to external storage, but I would have an issue with it being stored locally”
|
12008, female, 39, Control
|
‘Nuts and Bolts’- the practical experience of the ASICA trial
Participants who had used the ASICA app and participated in the intervention reported few technical problems. Most importantly there did not appear to be any particular issue experienced and associated with a single demographic characteristic. One significant issue was that one participant stated they had not received monthly prompts by text message. (11018, male 39, int). A further two participants reported that some photographs appeared to be missing from their digital skin maps. The hardware provided (Samsung Galaxy tablets) did appear to have created some technical problems with slow functioning and charging difficulties being mentioned. A barrier to use which was identified was the operating system of the tablet. See Table 6 for further details. Another issue expressed was the tablet’s camera - a key requirement of ASICA for reporting. Just under a quarter of the intervention group interviewed submitted poor quality photos (reported elsewhere; Murchie et al, in submission), hindering interpretation and assessment of the photographed lesion by the Clinical Nurse Specialist. This then required the submission of further photos, usually from their smartphone to enable the assessment to be completed.
In general, participation in the ASICA trial was viewed positively by most participants. Many expressed their interest in participating as having an altruistic intent, to improve care for others rather than to expect a personal benefit.
There were, however, contrasting views on the direction of influence of technology on health care in the future. Generally, most enthusiasm was expressed by younger participants and those from rural settings. One participant could perceive efficiencies of care, whilst another clearly felt that technology could not substitute for personal fact-to-face care.
Confidentiality and data protection are clearly important considerations when using technology to deliver healthcare although, notably, only one of the interviewees directly volunteered concerns about confidentiality. The concern was around their own device security rather than data misuse. See Table 5 for further details on this.
When asked about the qualities that that effective digital healthcare apps should possess. According to our study, they should be: participants reported coherent and consistent in purpose; straightforward; uncomplicated; and easy to use. It was also said that it is important that apps contain enough information for them to be used effectively and that they signpost the user to further help if needed.
Table 6
Participant experience of the ‘nuts and bolts’ of the trial
Analysis overview
|
Quote
|
Participant
|
Feedback on operating system and hardware
|
“I keep forgetting how, because I use Apple, so I keep forgetting how to turn it on and off, and whatever”
|
11022, female, 62, Intervention
|
“the Samsung app’s a bit slow and cumbersome and just not quite up to speed really is what the ipad is.”
|
11060, male, 54, Intervention
|
Issues around the camera on the hardware
|
“They didn’t get a good enough picture using the tablet, and so when, the guy phoned me back the next day, he said can you use your smart phone to take a picture, and then send through, because just because the, what he could see, like I’m not really sure what I’m looking at,”
|
11052, female, 48, Intervention
|
“when you’re trying to take photographs it, it’s very difficult to get the area of skin in focus”
|
12056, male, 60, Intervention
|
Problems in ASICA
|
“I had is there was one bit where there is no photograph, so I can’t for the life of me think which bit it is now, it was, but there’s one bit that I can’t check, because there aren’t any photographs, they just keep coming up blank,”
|
12035, female, 53, Intervention
|
ASICA: impact, design and usability
Feelings about using ASICA
In the ASICA trial, the primary outcomes measured were psychological wellbeing and quality of life measured by the Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADS) and the EQ5-D.[Murchie et al, 2019] A mixture of views were expressed on this point by the users interviewed here. Two participants indicated an initial increase in concern when they began using ASICA but suggested this decreased as they continued to use it. Another participant stated that the app didn’t change their worry level but suggested that this may not have been the case if they did not have regular access to specialists as part of ongoing scheduled melanoma follow-up. In contrast, some participants reported finding that they became less anxious when they started using ASICA and were positive about the app enabling people who are likely to worry, the opportunity for greater reassurance compared to less structured alternatives. Importantly it did not seem that the arrival of email or text prompts reminding participants to perform a TSSE led to an increase in anxiety. See Table 7 for full quotes.
Table 7
The views, experiences and feelings of participants on ASICA
Analysis overview
|
Quote
|
Participant
|
Feelings induced by app use: changes in worry level.
|
“It’s made me more aware, however, if you were inclined to be paranoid it’s, it’s, it’s quite scary when you’re not medical”
|
11013, female, 73, Intervention
|
“I was worrying anyway, and I think maybe the app, I was kind of getting over it a bit, and I think the app maybe just brought it back a bit”
“think having the app kind of brought it back for a while, and I think looking at the pictures didn’t really help that, to start with, but I kind of came okay again, with kind of regularly using it”
|
11054, female, 47, Intervention
|
“I don’t worry too much, because I am still under the hospital”
|
12035, female 53, Intervention
|
“I think it’s very reassuring that you know, if there is something, then you can go back to the pictures, and if you’re worried, you can go, you know, it’s very, it saves going to your GP if you’re worried about this, have you contacted anybody, so it kind of reminds you to also look after yourself, if I can put it that way, and it should make the more anxious, less anxious, but maybe not.”
|
11022, female, 62, Intervention
|
Ideas for improvement of ASICA
|
“you have to watch all the videos before you can just go into actually doing the, the, putting in your data, and that, so and that drives me mad”
|
11052, female, 48, Intervention
|
“I don’t know if there’s another format of sharing the, you know, so that they could be zoomed in on or moved or I don’t know, they were quite clunky to move around, and find the right bit and they weren’t that clear I don’t think to look at, they would need, I felt like they needed to be more close up”
|
11054, female, 47, Intervention
|
“I hate that ruddy bit of kit I’m supposed to sort of keep in communication with you, it’s a Samsung thing, I’m an Apple man, so I hate the damn thing, so that gets me frustrated, because I don’t understand”
|
11016, male, 86, Intervention
|
Semi-structured interview with Dermatology Nurse Practitioner
The semi-structured interview with the DNP could not be recorded due to technical problems, but field notes are included in Supplementary File S3. Direct quotes were not available due to technical difficulties in recording within Microsoft Teams.in. The interview followed the guide detailed in the methods. Table 8 below records the discussion points and a summary of the response given by the DNP according to field notes produced by FR.
Overall, the DNP was very positive about the ASICA trial, believing it could reduce workload and be effective as a method of delivering follow-up care for melanoma. He did not think it had increased participants’ cancer worries, and indeed felt that for many it had increased their motivation to check their own skin. with the perception of increased participant motivation. The DNP was enthusiastic about the training of Practice Nurses and Advanced Nurse Practitioners located in GP practices however, current levels of training were not viewed as adequate to be allow them to consistently and accurately triage skin lesions. The DNP did have several suggested points of improvement for the ASICA app, which would improve the experience and care provided for patients. Firstly, having the app on patients’ own devices or using a more appropriately sized device (i.e. a smartphone rather than a tablet), could reduce the need for participant training and improve image quality. Secondly, the removal of the autozoom feature of the app would improve picture quality. The DNP thought a screening tool to ensure that all images sent to clinicians were of appropriate quality would be a useful addition to the app. Finally, adding a message function enabling messages to be sent directly between the clinician and patient would improve care and reduce follow up work.
Barriers and facilitators to engaging with ASICA
It appeared that those who had completed follow-up and were no longer receiving regular hospital appointments especially liked using ASICA. One reported that it gave them a sense of ‘no-longer being off the radar’. Conversely, one intervention group participant said they relied and engaged less with ASICA after being initially enthusiastic since they still had ready access to a dermatologist and felt they were getting enough input from them. ASICA users also reported that it was more convenient to use the app to submit concerns about their skin rather than having to travel and park at hospital to attend out-patient appointments. There was a sense from some, however, of a certain unwillingness to completely trust the ability of the app to detect something as serious as cancer. This was underlined by another respondent concerned that the validity of ASICA had not been proven due to it being novel and untested. For this individual, the concern was mitigated by the safety net of still being in formal follow-up. The interviews were completed before the COVID-19 pandemic, so it was not possible to determine if experience of the pandemic had an influence on participants’ views.
Areas for ASICA improvement
The layout, design and functionality of the app were generally well-received and only a few participants offered feedback for improvement. The addition of a skip button to prevent the skin checking instructional videos playing in full each time was mentioned by two participants as a time saving measure. Further, the ability to pinch and zoom on skin-map digital photos and clearer orientation was also recommended. The largest area of feedback was that the app should be made available for different operating systems and devices, specifically Apple, so that future users could use the app on their own devices rather than the 7” tablets, which were reported as being awkward to use by some.
Table 8
The views and experiences of the ASICA dermatology nurse practitioner
Discussion Point
|
Summary of response
|
Participants from different sites
|
No issues detected. Good contact at Cambridge to liaise.
|
Participant Training
|
Training appropriate if problems arose participants sought help from friends or family
|
Perceptions of individuals who used app more often
|
No perception of demographic which was more likely to report concern. Had not considered rurality.
|
ASICA workload
|
Used around half of the time allocated 1 hr per day. Most of the workload generated at weekend.
A direct message function within the app would reduce follow-up workload.
Perceived most work generated by follow up especially the need to request additional images.
|
Used responsibly and sparingly
|
Generally used responsibly, a couple of participants used excessively. Mainly due to anxiety and seeking reassurance. Did not perceive that ASICA increased anxiety but rather generally anxious people used it more.
Was used inappropriately as a general skin health tool rather than as specifically for cancer follow up. When prompted this was inappropriate along with some general advice from CNS most seemed receptive.
|
Was primary site a focus of individuals
|
Perceived that a small number of participants focused solely on the primary site, but most appeared to do whole body examination.
DNP was more suspicious of new lesions on primary site due to risk of recurrence.
|
Quality of images submitted
|
High number of poor-quality images. Believed the autozoom feature of app and the size of the device contributed.
|
Patient defaults after initial contact
|
Perceived that there was a high rate of default (i.e. failure to respond to request for further information / images) but wasn’t sure why. Felt maybe people were unconcerned, went to their GP or were seen at in person follow up.
CNS felt could be too paternalistic to continuously chase individuals, during trial limited to 2 attempts to contact individuals.
|
Could a non-specialist be used in the process
|
Believes practice nurses could be trained to triage, reassure, flag concerns and refer to a specialist. Believes this could reduce workload. Believed training would need to be algorithmic as pattern recognition a key skill in dermatology
|
Why was non-specific benign used rather than a specific diagnosis
|
In the instance where this diagnosis was made, DNP felt quite confident it was nothing suspicious however due to lack of information (i.e. clear photos) could not classify further.
|