Experts identified 37 factors that may influence patients’ experience of total body photography for skin cancer screening and diagnosis.
In a two-round modified Delphi study, investigators identiified factors serving as baseline items for a patient-reported experience measure for total body photography (TBP). Candidate statements were developed through a targeted literature review and subject-expert input. The first round included 14 nurses or melanographers, 4 dermatologists, and 2 researchers involved in TBP capture, clinical use, or research. Nineteen experts completed the second round.
Consensus required at least 75% of the panelists to rate a statement as important, along with prespecified criteria for the distribution of responses. Among 37 statements considered in round one, 30 reached consensus. Following panel feedback, the investigators revised, removed, and introduced statements and a new section. In round two, 90% (n = 37/41) of the statements met consensus. Across both rounds, 82% (n = 37/45) of the statements were retained, including 29 original statements, two modified statements, and six new statements.
Communication, consent, comfort, and environment received the strongest agreement across the Delphi rounds. All of the panelists rated clarity of information about the purpose of imaging, risks, and patient rights as important. They also supported assessing how the health care team explained results or next steps and whether patients felt comfortable asking questions and receiving understandable answers.
All panelists rated staff friendliness, professionalism, and attention to patients’ physical and emotional comfort as important. They supported assessing whether patients felt respected and treated with dignity while prior to and during the procedure.
In round two, all panelists supported assessing satisfaction with the level of privacy offered during the procedure, including while changing and preparing for imaging. Physical comfort during imaging received 95% agreement.
In round two, all panelists supported assessing whether patients perceived TBP as contributing positively to their care and whether patients perceived imaging as improving early detection or diagnosis of skin cancer. Ninety-five percent supported assessing patients’ confidence in image quality and accuracy. The investigators did not test whether TBP improved clinical outcomes.
All panelists supported assessing the effects of health insurance coverage or out-of-pocket costs. Eighty-four percent supported assessing the effect of TBP performed alone or in combination with a full-body skin examination. The same proportion supported assessing whether willingness differed when TBP was recommended by a health care practitioner or pursued on the patient’s own initiative.
Experts showed less agreement about patients receiving or using copies of their images. In round one, 30% rated whether patients received a copy of their images as important, 55% supported assessing ease of image access, and 40% supported assessing whether images aided skin self-examination. The statements were removed following round one.
Panel feedback highlighted differences in how patients may respond to viewing TBP. While some patients appreciated viewing their images, others experienced distress and concerns related to body image. Evidence concerning patient access to other types of medical images may not fully reflect experiences with TBP. Further research into the effects of sharing full-body photographs with patients may be needed.
Candidate statements were generated using a rapid rather than systematic literature review, meaning some relevant factors may have been missed. Patients were also not included in the Delphi panel despite being central to the experience under consideration. The investigators considered the expert panel appropriate in identifying technical and procedural factors that may not be readily observable by patients.
Generalizability may also be limited because 85% of the panel practiced in Australia. Experiences associated with the recent integration of artificial intelligence into TBP were not included because patient awareness and understanding varied and its role in TBP remained ambiguous and largely experimental.
“Future research should focus on validating these findings with patients,” wrote lead study author Preksha Machaiya Kuppanda, of the Frazer Institute in the Faculty of Health, Medicine and Behavioural Sciences at The University of Queensland in Australia, and colleagues.
The study authors reported no conflicts of interest.
