Appendix: Clinician and patient perspectives on implementation of a remote interpretation model of reflectance confocal microscopy for skin cancer diagnosis: a qualitative study using an acceptability framework
Description
Non-invasive diagnostic technologies are a growing area of research and practice in dermatology, particularly in the treatment of skin cancers. Cutaneous confocal microscopy / Reflectance confocal microscopy (RCM) has been shown to increase diagnostic accuracy when interpreted at the bedside. If shown to be acceptable and feasible, a remote-RCM model using store-and-forward systems could potentially increase access to RCM and improve patient outcomes by improving diagnostic accuracy and reducing the number of unnecessary biopsies. To determine factors affecting the acceptability and feasibility of the remote-RCM model across five tertiary Australian dermatology centres from the perspective of patients and clinicians. Using a mixed methods approach, patients and clinicians involved in RCM image capture (technicians) or remote interpretation (readers based elsewhere) were invited to participate. Likert questionnaires were used to assess acceptability and willingness from the patients’ perspective to use remote-RCM again . Chi-squared tests measured differences between groups based on gender, rurality, number of previous melanomas and skin cancer surgeries. Semi-structured interviews were used to determine acceptability and feasibility from the clinicians’ perspective. Analysis of interview data used an inductive-deductive approach to thematic analysis. 166 patients completed the questionnaire, 73 (44%) of which were female, and of which 92.8% (154 /166) agreed that it was an acceptable process. 14 clinicians (5 readers; 9 technicians) were interviewed. Clinician’s perspective on acceptability was influenced by the perceived value of remote-RCM. The ability of the model to generate meaningful data that is useful to ongoing clinical practice was largely impacted by factors of technological connectivity, individuals’ motivation and self-efficacy. Contributing inner and outer setting constructs included technological supports, funding and cultural attitudes toward the model. Suggested strategies for real-word implementation should focus on training/support, rapid IT connectivity and infrastructure, and models for reimbursement and incentivisation. Conclusions Use of remote-RCM is seen as an acceptable application of RCM, with benefits to patients and clinicians, however considerations for implementation going forward need to address support for innovation, infrastructure, technology, personnel, and financial structures. These findings are relevant for ongoing effective and sustainable implementation of new teledermatological technologies. This dataset contains the external suppository/ appendix material.
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- University of Sydney