ORCID Profile
0000-0002-7533-1678
Current Organisation
Alfred Health
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: JMIR Publications Inc.
Date: 20-12-2022
DOI: 10.2196/40623
Abstract: The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP–led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of “medical overuse” and “high-value care.” Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. Australian and New Zealand Clinical Trials Registry ACTRN12616001716459 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865
Publisher: JMIR Publications Inc.
Date: 30-06-2022
Abstract: he large and growing number of melanoma patients who need long term surveillance increasingly exceeds capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to do skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are one potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care (e.g., dermatologists and general practitioners (GPs)). o explore perceptions of potential benefits and harms of mobile teledermoscopy, and experiences with this technology, among clinicians participating in a pilot randomised controlled trial (RCT) of patient-led melanoma surveillance. his qualitative study was nested within a pilot RCT conducted at dermatologist- and skin specialist GP-led melanoma clinics in New South Wales, Australia. We conducted semi-structured interviews with 8 of the total 11 clinicians who were involved in the trial: 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined interview). Thematic analysis was used to analyse the data with reference to concepts ‘medical overuse’ and ‘high-value care’. linicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns around use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medico-legal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty in order to decrease the potential for medical overuse, and by ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. linicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts, and to minimise potential harms from medical overuse.
Publisher: Springer Science and Business Media LLC
Date: 22-12-2021
DOI: 10.1007/S40257-020-00574-4
Abstract: Artificial intelligence (AI) algorithms have been shown to diagnose skin lesions with impressive accuracy in experimental settings. The majority of the literature to date has compared AI and dermatologists as opponents in skin cancer diagnosis. However, in the real-world clinical setting, the clinician will work in collaboration with AI. Existing evidence regarding the integration of such AI diagnostic tools into clinical practice is limited. Human factors, such as cognitive style, personality, experience, preferences, and attitudes may influence clinicians' use of AI. In this review, we consider these human factors and the potential cognitive errors, biases, and unintended consequences that could arise when using an AI skin cancer diagnostic tool in the real world. Integrating this knowledge in the design and implementation of AI technology will assist in ensuring that the end product can be used effectively. Dermatologist leadership in the development of these tools will further improve their clinical relevance and safety.
Publisher: Wiley
Date: 28-02-2020
DOI: 10.1002/IJC.32930
Start Date: 2017
End Date: 2019
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2019
End Date: 2022
Funder: National Health and Medical Research Council
View Funded Activity