In blok AB van jaar 4 (2023/2024) liep ik de interprofessionele huidtherapeutische stage van de Hogeschool Utrecht bij SkinVision. De onderzoeksvraag van mijn advies luidde: ''Op welke manieren wordt screening op huidkanker momenteel aangeboden aan ouderen en geestelijk of lichamelijk gehandicapten...
This advisory report highlights the urgent need for improved skin cancer screening in long-term care facilities, inspired by
observations of shortcomings during a fellow student's internship within disability care. This distressing reality showed
that many residents had suspicious skin patches, but the care facility lacked screening and carers lacked knowledge
about skin cancer.
The report explores the potential added value of SkinVision, originally designed for self-care individuals, within the context
of non-self-care individuals at increased risk of skin cancer.
Research design according to Design Thinking
The research, structured according to the principles of Design Thinking, includes several interviews with external and
internal SkinVision stakeholders. Four qualitative interviews were conducted with various external stakeholders on 17
November, 8, 11 and 22 December, namely two managers in a mentally and physically disabled facility, a specialist in
geriatrics and a dermatologist. In addition, a survey among caregivers was conducted and an analysis of scientific
literature within the Cochrane, Ebsco, PubMed and Wiley databases was being made. This approach provides a creative
approach to encourage innovation and enable involvement of different stakeholders.
Findings and Problem Analysis
The findings confirm that screening of elderly and disabled people in care facilities is deficient, with care priority issues,
lack of training for carers, lack of awareness, time and budget restrictions, and lack of clarity on responsibilities and
reimbursements being the main causes. Strong communication between primary and secondary care was identified as
crucial for innovative methods to actually have successful implementation in practice.
SWOT Analysis of Alternatives
Seven ideas were identified as having potential for innovation in skin cancer screening within this population. Analysis
revealed the three most promising ideas through this and afterwards, a SWOT analysis was conducted on these three
ideas, including Video consultations and Store & Forward teledermatology. SkinVision eventually emerged as the
strongest idea, with the potential of AI-driven skin cancer detection showing strong promise.
Conclusions and Recommendations
This advisory report advocates the implementation of the SkinVision app for enhanced skin cancer screening in long-term
care facilities. With a focus on user-friendliness, security, caregiver training, awareness, and ethics, along with
strengthened first- and second-line communication and cooperation, the report offers a comprehensive approach. The
report concludes that SkinVision is the most promising idea for improved skin cancer screening, given the specific needs
of the target population.
Thanks to the insights gained from the stakeholders during the study, relevant advice was drafted that contributed greatly
to the expertise of caregivers and care facilities in general in terms of skin cancer screening. Expertise is contributed
because their tasks are expanded, and they receive new training that creates greater awareness.
Due to time and expertise constraints, a follow-up study is recommended on this research project, in which the proposed
'Small Case Study' method will be able to ensure a practical evaluation of the app prototype. SkinVision can thus develop
an ethical and effective app aimed at improving the quality of life for elderly and disabled people in care facilities.
Why there is great need behind this, the best way to approach it and the steps it requires for successful implementation
was presented interactively to the SkinVision team on 18 January 2024 through a Google slides presentation and can be
seen at Appendix G.
, Phase 1: Empathize
Rationale
The relevance of this problem statement was drawn up because skin diseases, such as benign and malignant skin
tumors, are currently a major health problem in long-term care facilities and this significantly reduces the quality of life of a
large healthcare group within the Netherlands (Alonso-Belmonte et al., 2022). A recent study among 126 long-term care
facilities in the Netherlands shows that of all participating caregivers, 99.4% faced a dermatological problem in one or
more residents in the past three months, of which 62.5% of caregivers faced ten or more problems in the past three
months (S. F. K. Lubeek et al., 2017). A survey among caregivers found that 61.9% rated the training they received on
skin cancer care very poor or bad (Appendix E, question 8).
Hypothesis and research question
To explore the extent to which this finding is actually a problem in Dutch health care society, a hypothesis was drawn up
that stated that elderly and mentally or physically disabled people living in long-term care facilities are not being screened
for skin cancer or are being screened incompletely. From this hypothesis, the main question was formulated that will
guide and direct the research. The main question of this study is: ''In what ways is skin cancer screening care currently
provided for the elderly and mentally or physically disabled living in long-term care facilities, and in what ways can this
care provision be strengthened?''
The Why
The ‘Why’ for the researcher: As a prospective skin therapist, the researcher aims to improve the quality of life regarding
skin care for all target groups in the Netherlands by making health care accessible to all. Therefore, the researcher would
like to work to provide a solution for the elderly and disabled within long-term care facilities to ensure that they also
receive the skin care they need and are entitled to.
The ‘Why’ for SkinVision: This research proposal is relevant to SkinVision by raising awareness, increasing the user base
by addressing a whole new target audience, and identifying new segments within vulnerable populations in need of
guidance. These insights resulted from crucial conversations with SkinVisions key stakeholders (Appendixes A.1; A.2).
The How
Contextual interviews
Contextual interviews were conducted in the work environment of various internal and external stakeholders to get a clear
picture of the problem from different angles. Questions jointly prepared in advance were worked through during the
interview and hypothetical questions were used, such as 'Suppose that...'. This encouraged them to think more deeply
about how their experience would address certain care processes (Van 't Veer et al., 2020; Appendix B.1).
Survey among caregivers
The relevance of the issue was also strengthened by the launch of a survey among sixty caregivers working in long-term
care facilities. This survey was designed following the formation of an 'Empathy Map' that was used to gain in-depth
insight into the feelings, needs, experiences and considerations of this group (Van 't Veer et al., 2020). Through this
Empathy Map, the survey questions were jointly established (Appendix D.1.2; A.2.2; D.1.1; F.1.1).
95.2% indicated that no active skin cancer screening program is currently carried out (Appendix E, question 4). 90.5%
indicated that either skin cancer screenings were never performed, or this happened once a year, or the respondent did
not know how often this happened (Appendix E, question 6). 95.2% rated their current knowledge about skin cancer with
a one, two or three on a scale of one to five and the greatest burdens in performing skin cancer screenings were seen in
a lack of knowledge (40%) and lack of knowing its relevance (20%) (Appendix E, question 9; question 10). The greatest
demands within this target group appear to be new screening methods, new education among healthcare providers and
improving awareness (Appendix E, question 12).
Scientific literary research
In addition to obtaining qualitative data through interviews and surveys among stakeholders, quantitative data was
collected through collecting literary research from national scientific databases. This was done to strengthen the data from
the qualitative research so that the problem could be better defined in Phase 2.
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