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Two ways to improve patient comfort during skin cancer screening

Dermatologists might be able to improve patient comfort during skin cancer screening by respecting patient preferences for the physician’s gender and by allowing the patient the option of leaving on their undergarments, researchers suggested in a report published online in JAMA Dermatology (May 11, 2016).

“This study identifies barriers to getting skin checks. Giving patients choices that reduce embarrassment during an exam may make a person more likely to get regular skin checks, leading to higher rates of skin cancer detection,” said lead author Dr. Laura Ferris, associate professor, Department of Dermatology, Pitt School of Medicine and member of the Melanoma Program, University of Pittsburgh Cancer Institute.

During the study, the investigators administered an anonymous cross-sectional survey involving 443 adults undergoing a total-body skin examination for skin cancer.

The current study was born out of an observation from Dr. Ferris’ own dermatology practice. She explained that she found that many women wanted female physicians and were uncomfortable having male students in the room during their exams. She added that “while a strong preference for a same gender physician has been documented among patients undergoing colonoscopies, there wasn’t much data available about dermatology.”

Physician gender preference

Overall, the survey findings suggested that nearly all (99%) of the women preferred a female physician, and almost two-thirds of the men preferred a male physician.

Subsequently, the biggest predictor of preferring a female physician among women was being under age 30. Young women have one of the fastest growing rates of melanoma, so taking physician gender preference into account in this group may have an especially large impact, Dr. Ferris noted.

Undergarment preference

Typically, patients are asked to completely disrobe for a skin cancer screening. When asked about clothing preferences, nearly half of women and 40 per cent of men preferred to leave their undergarments in place during the exam.

“What we learned is that a substantial number of people preferred to leave their undergarments on and have us work around them,” said Dr. Ferris, who was quoted in a press release.

Less than 1% of melanomas are found in the genital region, so with 31% of women and 13% of men preferring not to have their genitals examined at all, another important message from the study is that physicians need to balance the benefit of occasionally finding a genital melanoma with causing many people discomfort or anxiety, she added.

The researchers are now focused on putting their findings into practice. “When we think about the relative risks and benefits of cancer screening, if we’re causing people discomfort, then we need to think of that as doing harm. Our study provides some easy ways to reduce that harm,” Dr. Ferris said.

“In the age of personalized medicine, taking simple steps, such as offering a choice of physician gender and degree of disrobement during an examination, can allow us to personalize the skin cancer screening examination to minimize discomfort,” she concluded.

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