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Randomized Intervention of Intensive vs Standard Education

Holly E. Clowers-Webb, MD; Leslie J. Christenson, MD; P. Kim Phillips, MD; Randall K. Roenigk, MD; Tri H. Nguyen, MD; Amy L. Weaver, MS; Clark C. Otley, MD

Arch Dermatol. 2006;142:712-718.

Objective  To determine whether an intensive educational program focused on the risk of skin cancer in organ transplant recipients, a population at high risk for development of skin cancer because of immunosuppression, produced measurable improvement in patient knowledge and sun-protective behavior.

Design  Patients were randomly assigned to receive standard episode-of-care–based education or intensive repetitive written education about skin cancer after organ transplantation. Preintervention knowledge was assessed and documented through a self-administered educational assessment tool. Retention of knowledge and the effect on sun-protective behavior were assessed with a follow-up questionnaire at 3 and 10 months.

Setting  Transplant center of an academic medical center.

Patients  Two hundred two patients presenting for transplant dermatologic consultation.

Intervention  Randomized intensive, repetitive written educational reinforcement.

Main Outcome Measures  Retention of knowledge and the effect on sun-protective behavior were assessed with a follow-up questionnaire at 3 and 10 months.

Results  Both intervention groups had similarly high baseline and 3- and 10-month scores on the knowledge portion of the surveys, and they had similar scores on the behavioral assessment portion of the surveys at baseline. Subjects receiving intensive education scored significantly better on the behavioral assessment at 3 and 10 months, although an improvement in knowledge was not documented.

Conclusions  This cohort of transplant recipients was well educated about skin cancer prevention before educational intervention and retained this knowledge. Patients who received the intensive educational intervention were significantly more compliant with recommendations for sun-protective behavior than those who received standard education, although differences in knowledge were not apparent. Lack of time and hassle were the most commonly cited barriers to behavioral compliance with sun protection.

Author Affiliations: Divisions of Dermatologic Surgery (Drs Clowers-Webb, Christenson, Phillips, Roenigk, Nguyen, and Otley) and Biostatistics (Ms Weaver), Mayo Clinic, Rochester, Minn.

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