Barriers and facilitators to seeking care for the initial diagnosis of melanoma in an urban safety-net hospital.

Abstract

e23123 Background: Unlike locally advanced melanoma, early-stage melanoma is highly curable. Yet, despite increased efforts that promote recognition of early-stage melanoma, many patients still present with locally advanced, thick primary tumors. This study focused on exploring patient reported factors influencing timely melanoma diagnosis. Methods: Using a mixed methods approach, we conducted semi-structured interviews exploring patient reported barriers and facilitators contributing to timely care for melanoma. Interviews were coded using a directed content analysis approach to generate themes within and across transcripts. Utilizing bivariate models, we examined the association between participant demographic factors and mean tumor thickness. Results: Participants (n = 14) were primarily recruited from Bellevue Hospital (n = 9), one of the largest public hospitals in the United States serving mainly underserved communities, and the Skin and Cancer Clinic at NYU Langone Health (n = 5). The median age at diagnosis was 59 years. Participants were mainly non-Hispanic White (85.7%), male (57.1%), and had incomes below $40,000 (57%). Nearly three-quarters were publicly insured (71%). Mean tumor thickness was 1.8 mm (range 0-9 mm). There were no statistically significant differences in tumor thickness between male and females; or between patients with annual incomes less than, or greater than $40,000. Participants with a highest education level of high school or equivalent or less (n = 3) had a mean tumor thickness of 4.4 mm (SD = 3.97); compared to undergraduate level (n = 4) with a mean tumor thickness of 2.1 mm (SD = 3.29); or graduate level (n = 7) with a mean tumor thickness of 0.5 mm (SD = 0.95), p = 0.096. Thematic analyses highlighted common barriers and facilitators to accessing care across patients. These barriers included: lack of melanoma awareness; lack of knowledge of risk factors and preventative efforts; perceived low susceptibility; inadequate health insurance. Common facilitators included: encouragement from family or friends to seek care; and noticing something changing or unusual on their skin. Participants recommended the use of strategically placed advertisements (e.g. billboards at beaches) and social media to increase knowledge about melanoma. Conclusions: The results of this pilot study emphasize the multiple personal and system-level barriers faced by the majority of patients who primarily utilize an urban public safety net hospital to obtain timely diagnosis of melanoma. Community-based efforts to increase melanoma awareness and access to care for this population may potentially reduce the diagnosis of thick primary melanomas.