Melanoma risk assessment and management: a qualitative study among Australian general practitioners

Background: Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. There has been no previous research into how physicians approach the selection and management of high-risk individuals. Melanoma risk prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically. Aim: To examine how general practitioners (GPs) assessed and managed melanoma risk, and the opportunities for using melanoma risk prediction models in primary care. Design and Setting: Semi-structured telephone interviews were conducted with 20 Australian GPs. Method: We purposively sampled and recruited from GPs who had completed a cross-sectional online questionnaire study on melanoma risk. Semi-structured telephone interviews were conducted with Australian GPs between July 9 and September 10, 2019. Interviews were audio-recorded, professionally transcribed, and analysed using grounded theory. Results: We found that melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between physicians on the identification of melanoma risk factors, melanoma risk estimation, management and patient education due to intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk prediction models, sharing facilitators and barriers to their potential implementation. Conclusions: Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk assessment and management processes.