Patients at elevated risk of melanoma: Individual predictors of non-compliance to GP referral for a dermatologist consultation

- This study reports on patient compliance in a pilot melanoma targeted screening.
- Four out of ten patients did not consult the dermatologist despite GP referral.
- Non-compliance was associated with reporting that GP advice was unclear (OR = 13.22).
- Non-compliant patients reported having no time and few concerns about melanoma.
- Physician counseling is a key factor in encouraging compliance.

ObjectiveThe aim of this study is to assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a General Practitioner referral and to determine individual predictors of non-compliance.MethodThis survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011.Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment).Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression.ResultsCompliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR = 13.22; [7.66-23.56]); no previous participation in cancer screenings, including smear tests (OR = 5.03; [2.23-11.83]) and prostate screening (OR = 2.04; [1.06-3.97]); lack of knowledge that melanoma was a type of cancer (OR = 1.94; [1.29-2.92]); and reporting no time to make an appointment (OR = 2.08; [1.82-2.38]), forgetting to make an appointment (OR = 1.26; [1.08-1.46]), long delays in accessing an appointment (OR = 1.25; [1.12-1.41]), not being afraid of detecting something abnormal (OR = 1.54; [1.35-1.78]), no need to consult a dermatologist to feel secure (OR = 1.28; [1.09-1.51]).ConclusionPhysicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better General Practitioner counseling might enhance compliance in high-risk populations.