Patients at elevated risk of melanoma: individual predictors of non-compliance to GP referral for a dermatologist consultation

Prev Med. 2014 Jul:64:48-53. doi: 10.1016/j.ypmed.2014.03.029. Epub 2014 Apr 12.

Abstract

Objective: The aim of this study is to assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a General Practitioner referral and to determine individual predictors of non-compliance.

Method: This survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011. Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment). Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression.

Results: Compliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR=13.22; [7.66-23.56]); no previous participation in cancer screenings, including smear tests (OR=5.03; [2.23-11.83]) and prostate screening (OR=2.04; [1.06-3.97]); lack of knowledge that melanoma was a type of cancer (OR=1.94; [1.29-2.92]); and reporting no time to make an appointment (OR=2.08; [1.82-2.38]), forgetting to make an appointment (OR=1.26; [1.08-1.46]), long delays in accessing an appointment (OR=1.25; [1.12-1.41]), not being afraid of detecting something abnormal (OR=1.54; [1.35-1.78]), no need to consult a dermatologist to feel secure (OR=1.28; [1.09-1.51]).

Conclusion: Physicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better General Practitioner counseling might enhance compliance in high-risk populations.

Keywords: Clinical pathway; Health belief model; Melanoma; Patient compliance; Screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Counseling
  • Dermatology / statistics & numerical data*
  • Early Detection of Cancer / statistics & numerical data*
  • Educational Status
  • Female
  • France
  • General Practitioners / standards
  • General Practitioners / statistics & numerical data*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Melanoma / diagnosis
  • Melanoma / prevention & control*
  • Middle Aged
  • Occupations
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data*
  • Physician-Patient Relations*
  • Pilot Projects
  • Practice Patterns, Physicians' / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Risk Assessment
  • Time Factors