Monday, July 25, 2016

Stepping up counseling about sun safety

- Jennifer Middleton, MD, MPH

The U.S. Preventive Services Task Force (USPSTF) is currently updating its 2012 recommendations regarding counseling to prevent skin cancer, and it couldn’t come at a better time, as the incidence of malignant melanoma continues to rise. The USPSTF found previously that counseling fair-skinned individuals aged 10-24 increases the use of sun-protective behaviors, but this counseling isn’t happening frequently enough in primary care.

A 2004 study of family physicians found that only 60% were routinely providing counseling about sun protection and skin cancer prevention; commonly cited barriers to doing so included lack of time and limited information about the effectiveness of counseling. A more comprehensive survey in 2014 found that family physicians provided sun safety counseling far less frequently, and usually only in association with specific patient diagnoses such as actinic keratosis or a history of other skin problems. In contrast to what the evidence supports, the age group most likely to receive counseling in this study was adults in their 70s; counseling at child and young adult visits was rare. Since only 30% of adults regularly follow sun safety practices, and tanning in young adults remains highly prevalent, there are ample opportunities for family physicians to make a difference for our patients by providing this counseling.

Other effective interventions may be worth incorporating into your practice as well. Mailing personalized handouts about skin cancer prevention increased sun safety behaviors (use of sunscreen, protective clothing, hats, and sun avoidance) more than providing generic handouts in one study. In another study, calculating a melanoma risk score (SAMScore) and targeting counseling to patients at higher risk decreased sunbathing. Counseling young adults about tanning should elicit the specific reasons why they tan; physicians can then target their messages, such as discussing sunless tanning products, alternative methods to relax, or debunking the myth that a tan protects against further skin damage. 

Helping patients adopt healthier behaviors is an important part of the primary care clinician's role, and applying motivational interviewing techniques along with tailoring our counseling to each patient’s stage of change may be useful. Having a structured practice intervention to help patients adopt sun safety measures may also reduce the burden on individual clinicians.

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