Improving Skin Care and Cancer Prevention Patient Education: A DNP Project Michigan State University School of Nursing Demetria McDuffey and Brooke Sandifer Faculty Advisor: Kara Schrader, DNP, FNP-C Skin Cancer Intro/Background ▪ Most common and preventable cancer ▪ 1 in 5 people will develop skin cancer ▪ 9,500 people diagnosed daily ▪ Two groups: ▪ Melanoma ▪ Non-Melanoma ▪ Associated with large health care costs (Centers for Disease Control [CDC], 2022); American Academy of Dermatology Association [AAD], 2022 Skin Cancer Intro/Background continued.... ▪ Disparities and misconceptions exist ▪ Highest incidence rates: Non-Hispanic whites ▪ Lowest incidence rates: African Americans and Latinos ▪ Minimal guidelines to no guidelines for skin cancer screening ▪ Everyone should be educated! (Alberg et al., 2020; AAD, 2022; United States Preventative Services Task Force [USPSTF], 2016) Problem Statement ▪ Limited curriculum ▪ Lack of proper knowledge ▪ Lack of confidence Review of Literature ▪ Search engines ▪ PubMed ▪ Cumulative Index to Nursing and Allied Health Literature (CINAHL) ▪ Key words ▪ Provider* ▪ Train* ▪ Educat* ▪ "Skin cancer" OR melanoma OR "basal cell carcinoma" ▪ (("skin cancer" OR melanoma OR "basal cell carcinoma") AND (provider")) AND (educat*) ▪ Inclusion criteria ▪ English ▪ Published in the last 5 years ▪ 6 articles used ▪ Themes ▪ Online based courses ▪ Interactive methods ▪ Live synchronous courses Site description Primary Care Clinic in Mid-Michigan with four providers: ▪ 2 Nurse Practitioner (NP) ▪ 1 Medical Doctor (M.D.) ▪ 1 Doctor of Osteopathic Medicine (D.O.) SWOT Analysis Strengths Weaknesses • Accessible information in the EHR • Accessible information limited to the EHR only • Facility team member seeks change • Lack of provider education and training • Limited time during appointments Threats Opportunities • Lack of financial resources • Increased provider knowledge and confidence • Lack of provider interest • Better patient outcomes • Lack of provider participation • Decrease mortality and morbidity • Staff not using new education they’re given in practice Project Description Theoretical Framework/Practice model Model of Improvement ▪ Accelerate improvement (Institute for Healthcare Improvement [IHI,2022]). ▪ Associated with improved patient outcomes (Taylor et al., 2014). ▪ Creates an environment for increased confidence (Taylor et al., 2014). ▪ Two Sections to the model • 3 fundamental questions involving: the projects aim, assess the effectiveness, and determining the changes that will occur (IHI, 2022). • PDSA: Plan, Do, Study, Act (IHI, 2022). Methods ▪ Knowledge Assessment ▪ Pre-test ▪ Post-test ▪ Confidence Assessment ▪ Likert Scale- pre/post survey Cost Analysis Evaluation/Outcome ▪ Small sample size ▪ Effectiveness difficult to determine ▪ Broaden audience by uploading to a larger platform Implications for Nursing ▪ Gaps in provider counseling on skin cancer due to lack of knowledge and confidence ▪ Evidence showed that web-based education was effective Sustainability ▪ Feasible ▪ No additional cost to the clinic ▪ Easy access to other clinics and health systems via YouTube ▪ Test and Surveys can be created online Conclusion ▪ Lack of confidence patient education ▪ Lack of provider knowledge ▪ Association with high healthcare costs and mortality rates ▪ Inconclusive results ▪ Expansion to a broader audience needed References ▪ American Academy of Dermatology Association (2022). Skin Cancer. https://www.aad.org/media/stats-skin- cancer ▪ Alberg, A. J., LoConte, N. K., Foxhall, L., Weinstock, M. A., Gomez, S. L., Francisco, M., ... & Gershenwald, J. E. (2020). American society of clinical oncology policy statement on skin cancer prevention. JCO oncology practice, 16(8), 490-499. https://www.doi.org/10.1200/JOP.19.00585 ▪ Centers for Disease Control and Prevention (2022). Skin Cancer. https://www.cdc.gov/cancer/skin/basic_info/what-is-skin-cancer.htm ▪ Institute of Healthcare Improvement. (2022). Science of Improvement: Testing Changes. Retrieved August 24, 2022, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.asp ▪ Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed J.E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety 23(4), pp 290-298. https://www.doi.org/10.1136/bmjqs-2013-001862 ▪ United States Preventative Services Task Force (2016). Screening for skin cancer: US Preventative Services Task Force recommendation statement. Journal of the American Medical Association, 316(4), pp 429-435. https://doi.org/10.1001/jama.2016.8465 Acknowledgements ▪ Faculty Advisor: Dr. Kara Schrader, DNP, FNP-C ▪ Community Partner: Kimberly Elmo ▪ Clinic providers Questions ?