Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT: A Randomized Controlled Trial.

BACKGROUND: Survivors of hematopoietic cell transplantation (HCT) have an increased risk of skin cancer, yet adherence to recommended skin self-examination (SSE) and annual physician skin examinations is low. Scalable strategies to improve screening in this high-risk population are needed. PATIENTS AND METHODS: We conducted a randomized controlled trial of 720 adult survivors of HCT enrolled between October 30, 2020, and December 13, 2023. Participants received remotely delivered print materials and 12 educational text messages over 9 months (patient activation and education [PAE]). In the PAE plus physician activation group (PAE + Phys), providers also received educational materials and guidance on performing skin examinations. Primary outcomes were participant-reported SSE within the prior 2 months and physician skin examination within the prior 12 months, assessed at baseline and 12 months. Secondary outcomes included the number of body regions examined and skin cancer knowledge. RESULTS: Median age at enrollment was 61 years (range, 18-81), and the median time from HCT until enrollment was 3.1 years (range, 1.7-5.3). The proportion of participants reporting both physician skin examination and SSE increased in both groups, from 15.8% to 47.5% in the PAE group (odds ratio [OR], 4.98; 95% CI, 3.54-7.02) and from 18.0% to 52.1% in the PAE + Phys group (OR, 5.49; 95% CI, 4.03-7.50), with no significant between-group difference. SSE increased significantly in both groups, from 34.7% to 81.5% in the PAE group and from 31.5% to 79.0% in the PAE + Phys group, without no significant between-group difference. Physician skin examinations increased from 32.1% to 55.3% in the PAE group and from 33.2% to 64.8% in the PAE + Phys group, with a significantly greater increase in the PAE + Phys group (P=.01). The mean number of body regions examined more than doubled in both groups, and skin cancer knowledge and self-efficacy improved significantly. CONCLUSIONS: Remotely delivered interventions improved skin cancer screening among HCT survivors. Patient activation substantially increased SSE, whereas physician activation provided additional benefit for physician-performed skin examinations. These findings suggest that physician activation enhances clinician-performed screening and supports scalable survivorship care models for high-risk populations. CLINICALTRIALS: gov identifier: NCT04358276.