Enhancing Patients’ Satisfaction and Sun-Protective Behaviors Using the ABC Method of Physician-Patient Communication

The incidence and mortality rates from skin cancer have been rapidly increasing in the United States in recent decades, particularly among individuals aged 15 to 39 years,¹ emphasizing the need for individuals to establish habits of sun protection. Despite knowing the dangers associated with UV light (UVL) exposure, many individuals do not practice sun-protection behaviors.² Physician-patient communication, along with the availability of appropriate information, is necessary to elicit essential behavior change and consequential use of sun protection among patients. Research has shown that communication methods using motivational interviewing measures for a patient-centered approach have positively improved numerous health-related habits and behaviors.³

To optimize physician-patient communications about UVL protection, Mallett and colleagues⁴ developed the ABC (Addressing Behavior Change) method of physician-patient communication for use by dermatologists during a routine office visit that includes a skin examination. The ABC intervention is a 2- to 3-minute conversational tool used to enhance patients' sunscreen use and sun-protective behaviors made up of 6 components based exclusively on motivational interviewing principles: (1) assess UVL exposure; (2) assess sunscreen use; (3) explore barriers to sunscreen use; (4) facilitate removal of barriers to sunscreen use; (5) assess additional use of sun protection; and (6) summarize patients' motivations and ideas for improved sunscreen use. Recent research has found that dermatologists who used the ABC intervention liked it, were able to learn it quickly, and used it with good fidelity over an extended period (6 months).⁴

The focus of the present study was to evaluate the effects of the ABC intervention on patient outcomes to determine if this technique is associated with improvement in patient satisfaction and immediate intentions to enhance their sun-protective behaviors.

Participants consisted of 60 patients from 2 research sites (30 per site; 75% women). Data were collected during the late summer, and the institutional review board at each site approved the research protocol. The Milton S. Hershey Medical Center at The Pennsylvania State University served as the treatment site because the dermatologists there were already trained to perform the ABC intervention; the Northwestern University Faculty Foundation (NWFF) served as the control site. Participants included adult individuals who were scheduled to receive a skin examination during their appointment and did not meet any exclusion criteria. Exclusion criteria consisted of (1) a history of psoriasis; (2) a complicated presenting problem that required the full duration of the office visit; and/or (3) a demonstrated communication barrier (eg, mental disability). Participants in each condition completed identical surveys after their office visit was complete to assess patient satisfaction with the visit, their intentions to use sunscreen, and their perception of information about sun protection communicated by their dermatologist.

Participants who had an appointment that included a skin examination were recruited the day of their office visit. Prior to the examination, a research assistant obtained the patient's consent to participate in the study. Participants agreed to fill out a brief, 5-minute survey at the end of their visit and have their appointment audio recorded to document the delivery of the intervention. After the visit, participants were escorted to a designated area to complete the anonymous survey. Participants received a $20 gift card for their time.

Participants in the control group were approached by research assistants after their visit and asked to complete the same brief anonymous survey as the treatment group. Control participants received a routine skin examination and engaged in treatment-as-usual physician-patient communication, since the NWFF dermatologists had no previous exposure to or training in the ABC invention. Control participants did not receive additional compensation.

Response rates were consistent across sites (97% for both treatment and control). Patients in the treatment group reported significantly higher intentions to increase overall sunscreen use and to use sunscreen before outdoor activities compared with the control group, and patients in the treatment group were also significantly more satisfied with their physician communication practices than the controls (Table 1). Treatment-group patients also reported that their dermatologists were more likely to cover each of the 6 components of the ABC intervention than patients who received usual care (Table 2).

The findings of the study demonstrate that patients who received the ABC intervention from dermatologists trained in delivering this innovative communication method reported higher satisfaction with their care and had stronger intentions to increase sunscreen use and practice sun-protective behaviors than patients who received traditional physician care and communication. These findings, coupled with previous reports of dermatologists' positive experiences with the ABC intervention and ability to maintain good fidelity over time,⁴ show promise for a brief and sustainable physician-delivered intervention to enhance both patient satisfaction with care and UV protective behaviors in a dermatologic setting. Future studies will examine the efficacy of the ABC method on enhancing patients' sun-protective behaviors to assess how physicians' use of the intervention positively influences patients' actions over time.

Correspondence: Dr Mallett, Prevention Research Center, The Pennsylvania State University, 204 E Calder Way, Ste 208, State College, PA 16801 (kmallett@psu.edu).

Accepted for Publication: March 18, 2012.

Author Contributions: Drs Mallett and Turrisi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Mallett, Turrisi, and Billingsley. Acquisition of data: Mallett, Turrisi, Comer, Read, Varvil-Weld, Gaber, Favero, Guttman, and Robinson. Analysis and interpretation of data: Mallett, Turrisi, and Comer. Drafting of the manuscript: Mallett, Comer, Read, and Favero. Critical revision of the manuscript for important intellectual content: Mallett, Turrisi, Billingsley, Comer, Varvil-Weld, Gaber, Guttman, and Robinson. Statistical analysis: Mallett and Turrisi. Obtained funding: Mallett, and Turrisi. Administrative, technical, and material support: Comer, Read, Favero, Guttman, and Robinson. Study supervision: Turrisi.

Funding/Support: This study was supported in part by National Cancer Institute grant R03 CA144435 (Dr Mallett).