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Cited by 61Cutaneous Melanoma Detection and ManagementTelemedicine and Telehealth ImplementationEconomic and Environmental Valuation

Consumer preferences for teledermoscopy screening to detect melanoma early

Open access
Spinks, Jean, Janda, Monika, Soyer, H Peter, Whitty, Jennifer A·2016·Journal of Telemedicine and Telecare
DOI 10.1177/1357633x15586701
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Abstract

Introduction: ‘Store and forward’ teledermoscopy is a technology with potential advantages for melanoma screening. Any large-scale implementation of this technology is dependent on consumer acceptance. Aim: To investigate preferences for melanoma screening options compared with skin self-examination in adults considered to be at increased risk of developing skin cancer. Methods: A discrete choice experiment was completed by 35 consumers, all of whom had prior experience with the use of teledermoscopy, in Queensland, Australia. Participants made 12 choices between screening alternatives described by seven attributes including monetary cost. A mixed logit model was used to estimate the relative weights that consumers place on different aspects of screening, along with the marginal willingness to pay for teledermoscopy as opposed to screening at a clinic. Results: Overall, participants preferred screening/diagnosis by a health professional rather than skin self-examination. Key drivers of screening choice were for results to be reviewed by a dermatologist; a higher detection rate; fewer non-cancerous moles being removed in relation to every skin cancer detected; and less time spent away from usual activities. On average, participants were willing to pay AUD110 to have teledermoscopy with dermatologist review available to them as a screening option. Discussion and conclusions: Consumers preferentially value aspects of care that are more feasible with a teledermoscopy screening model, as compared with other skin cancer screening and diagnosis options. This study adds to previous literature in the area which has relied on the use of consumer satisfaction scales to assess the acceptability of teledermoscopy.

AI snapshot

Written from the paper’s full text.

TL;DR

In a discrete choice experiment with 35 Queensland consumers at increased melanoma risk and prior teledermoscopy experience, participants preferred screening by a health professional over skin self-examination. They especially valued dermatologist review, higher melanoma detection, fewer non-cancerous moles removed, and lower cost, with an average willingness to pay of AU$110 for teledermoscopy with dermatologist review as an additional screening option.

Key findings

  • Participants strongly preferred having screening results reviewed by a dermatologist rather than a GP, a higher chance (>95%) of detection, fewer non-cancerous moles removed (3 vs 10 per skin cancer detected), and lower cost (all p-values <0.05).
  • Avoiding more than 4 hours away from usual activities was preferred but significant only at the 10% level; no significant difference was found between screening methods (teledermoscopy vs skin cancer clinic vs GP).
  • Skin self-examination was chosen in 36 of 420 choice sets (8.6%) by 6 participants, and no participants chose “no screening.”
  • The estimated marginal willingness to pay for adding teledermoscopy with dermatologist review as a fourth screening option was AU$110 on average; after introduction, teledermoscopy had the highest probability of uptake (0.668), compared with skin cancer clinic 0.183 and GP 0.136. If dermatologists staffed skin cancer clinics, the welfare gain fell to AU$52.

Methods

  • A discrete choice experiment was completed by 35 consumers in Queensland, Australia, all with prior teledermoscopy experience from a pilot trial; participants were aged 50–64 years and considered at moderate or high risk for melanoma.
  • Participants made 12 choices between two generic screening alternatives described by seven attributes, with opt-out options of skin self-examination or no screening; two survey versions were used, with 16/35 completing version 1 and 19/35 version 2.
  • Data were analyzed with a mixed multinomial logit model; all attributes except cost were effects coded, cost was continuous, random parameters were initially modeled with normal distributions and 1000 Halton draws, and willingness to pay was estimated using the Small and Rosen compensating variation method.

Limitations

  • The paper states the sample was small and homogeneous, all participants had prior teledermoscopy experience, and all were at moderate to high risk of melanoma, limiting generalizability.
  • The paper states results are specific to the Australian health system, where GP visits are publicly funded and dermatologist access requires GP referral, so they cannot inform policy makers in other countries without further confirmation.
  • The paper states the choice questions had not been tested previously; evident from the text, the sample was also highly educated and high-income, predominantly from major cities, and the DCE elicited hypothetical choices rather than observed screening behavior.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/1357633x15586701

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 32 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    No significant difference was found between teledermoscopy, skin cancer clinic, and GP screening methods in their effect on screening choice.

    “No significant difference was found between the different screening methods in terms of their effect on screening choice (teledermoscopy compared to visiting a skin cancer clinic or a GP).”
    Quote in the paperSubstantial claim
  • Findingown data

    No participants chose the 'I would prefer not to undertake any screening' opt-out option.

    “No respondents opted for the alternative 'no screening'”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants preferred that fewer non-cancerous moles (3) are removed to detect one skin cancer, rather than more (10).

    “that less non-cancerous moles (3) are removed to detect one skin cancer, rather than more (10)”
    Quote in the paperNot a substantial claim
  • Findingown data

    None of the tested additional variables (socio-demographics, prior skin cancer diagnosis, skin cancer detected during trial, worry about developing skin cancer, current skin self-examination) significantly explained heterogeneity around choices.

    “None of these variables were shown to significantly explain heterogeneity around choices and they were therefore excluded from the final model.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants strongly preferred their screening results to be reviewed by a dermatologist rather than a GP.

    “Participants strongly preferred their screening results to be reviewed by a dermatologist rather than a GP”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 13
  • May combine two claims. 12

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Completed DCE surveys were returned by 35 participants (70% participation rate).

    “Completed DCE surveys were returned by 35 participants (70% participation rate).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Not spending greater than 4 hours away from usual activities was preferred, but this was only significant at the 10% level.

    “Not spending greater than 4 hours away from usual activities was preferred, but this was only significant at the 10% level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The estimate of welfare gain is sensitive to the assumption that skin cancer clinics are staffed by GPs rather than dermatologists, and drops to AU$52 if this assumption is not met in practice.

    “This estimate is also sensitive to the assumption that skin cancer clinics are staffed by GPs rather than dermatologists and the estimate drops to AU$52 if this assumption is not met in practice.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Skin cancer clinics are staffed by GPs rather than dermatologists.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Many of the results supporting the importance of particular attributes in this study are in concordance with previous literature on consumer satisfaction with teledermoscopy or teledermatology.

    “Many of the results found supporting the importance of particular attributes in this study are in concordance with the previous literature focusing on consumer satisfaction with teledermoscopy or teledermatology more broadly [14,18,19,27,28].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [14] source

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    • cites [18] source

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    • cites [27] source

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    • cites [28] source

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  • May combine two claims.

    Premisecitation

    Teledermoscopy images reviewed by an experienced teledermatologist have high concordance with face-to-face diagnoses, approximating 100% sensitivity and around 90% specificity to differentially diagnose melanoma and non-melanoma skin cancers.

    “Studies have found that results from teledermoscopy images, reviewed by an experienced teledermatologist, have high concordance with face-to-face diagnoses, as well as approximating 100% sensitivity and around 90% specificity to differentially diagnose melanoma and non-melanoma skin cancers [11][12][13][14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11][12][13][14]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The survey containing the DCE was developed and administered according to best practice guidelines.

    “A survey containing a DCE was developed and administered according to best practice guidelines [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumer preferences for teledermoscopy have predominantly been measured by consumer satisfaction rating scales, with somewhat mixed results.

    “Consumer preferences have predominantly been measured by 'consumer satisfaction' rating scales, with somewhat mixed results [16][17][18][19][20][21][22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16][17][18][19][20][21][22]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Two versions of the survey were created with 12 unique choice questions each, and participants were randomly allocated to each version to reduce participant burden.

    “To reduce participant burden, two versions of the survey were created with 12 unique choice questions contained in each version; participants were randomly allocated to each version.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A Discrete Choice Experiment (DCE) is a type of survey which elicits consumer preferences around service delivery in a number of different disciplines, including increasingly in health.

    “A Discrete Choice Experiment (DCE) is a type of survey which elicits consumer preferences around service delivery in a number of different disciplines, including increasingly in health [23][24][25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23][24][25]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The DCE data were analysed using a mixed-logit model (MMNL), which offers advantages over the more often used multinominal logit (MNL).

    “Here, we use a mixed-logit model (MMNL) which offers advantages to the more often used multinominal logit (MNL) [32,33].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [32] source

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    • cites [33] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There were no missing choice data.

    “There were no missing choice data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A constraint was added to the design to avoid unrealistic combinations: review by a GP was constrained to appear only with screening at a skin cancer or GP clinic, whereas teledermoscopy could be reviewed by either a GP or a dermatologist.

    “Specifically, review by a GP was constrained to only appear with screening being performed at a skin cancer or GP clinic; whereas, screening by teledermoscopy could be reviewed by either a GP or a dermatologist.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Teledermoscopy has the potential to assist with managing clinician workloads, increasing access to dermatologists and potentially avoiding unnecessary biopsies and other investigations which occur at a higher rate when performed by non-dermatologist and less experienced clinicians.

    “Thus, teledermoscopy has the potential to assist with managing clinician workloads, increasing access to dermatologists and potentially avoiding unnecessary biopsies and other investigations which occur at a higher rate when performed by non-dermatologist and less experienced clinicians [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The screening alternatives and attribute levels were chosen based on results of three previous surveys in the target group, a literature review, and included important screening outcome, financial and convenience considerations.

    “These alternatives, and the different attribute levels over which they vary, were chosen based on the results of three previous surveys undertaken in the target group [11], as well as a literature review [14, 16-22, 27, 28] and included important screening outcome, financial and convenience considerations.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [11] source

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    • cites [14] source

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    • cites [16] source

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    • cites [17] source

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    • cites [18] source

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    • cites [19] source

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    • cites [21] source

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    • cites [22] source

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    • cites [27] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A review by Demiris et al. (2004) identified 14 studies related to consumer satisfaction and acceptance of teledermatology applications and concluded that satisfaction is multidimensional, covering convenience of the service, confidence in the result, and ease of communication with the clinician.

    “The authors concluded that the concept of satisfaction is multidimensional and should cover many underlying factors including convenience of the service; confidence in the result; and ease of communication with the clinician [18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Demiris et al. (2004)

      Not checked in the free run.

    • cites [18] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Teledermoscopy is an innovative technology which potentially offers at least equivalent health outcomes for consumers, delivered in a more acceptable way and may offer improved health service efficiency.

    “Teledermoscopy is an innovative technology which potentially offers at least equivalent health outcomes for consumers, delivered in a more acceptable way and may offer improved health service efficiency.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Whited et al. found that the majority of consumers agreed they had confidence that dermatologists can diagnose teledermatology pictures and that a teledermatology consult is more convenient than going to a dermatologist clinic.

    “For example, Whited et al. found that the majority of consumers agreed that they had confidence that dermatologists can diagnose teledermatology pictures and that a teledermatology consult is more convenient than going to a dermatologist clinic [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Collins et al. showed no difference in overall satisfaction depending on type of consultation (face to face vs teledermatology) and both groups were happy with their care.

    “Qualitative and quantitative results from Collins et al. show no difference in the overall satisfaction depending on the type of consultation (face to face compared with teledermatology) [17] and that both groups were happy with their care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The use of DCE methodology here is an advance on existing literature which relied on satisfaction rating scales that do not allow relative importance of different aspects of the service to be directly compared.

    “The use of a DCE methodology here is an advance on the existing literature which relied on the use of satisfaction rating scales, which don't allow for the relative importance of different aspects of the service to be directly compared [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Due to the particular nature of the Australian health service, where GP visits are publicly funded and access to a dermatologist requires a GP referral, results cannot inform policy makers in other countries without further confirmation.

    “Further, due to the particular nature of the Australian health service, where GP visits are publicly funded and access to a dermatologist requires a GP referral, results cannot inform policy makers in other countries without further confirmation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Azfar et al. found that the majority (40%) of participants would be willing to wait 1-3 days for a response from mobile teledermatology, compared with 19% who wanted the answer on the same day.

    “Interestingly, the majority (40%) of participants answered 1-3 days compared with 19% who wanted the answer on the same day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Azfar et al.

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    Consumer acceptance of teledermoscopy is essential if broad implementation of the strategy is to be considered.

    “However consumer acceptance of this approach has yet to be established and is essential if broad implementation of this strategy is to be considered.”

  • The paper relies on this without support.

    Satisfaction rating scales are unidimensional.

    “However, one of the main limitations with using satisfaction rating scales is that they are unidimensional.”

  • The authors state this as an assumption.

    Skin self-examination is the base alternative and its utility is constant.

    “Instead, skin-self-examination was assumed to be the base alternative, the utility of which was assumed to be constant.”

  • The authors state this as an assumption.

    Distributions around random parameters are normal.

    “All distributions around random parameters were assumed to be normal and estimated using 1000 halton draws”

  • The authors state this as an assumption.

    There is no prior information about the likely magnitude or direction of coefficients (zero priors).

    “assuming no prior information about the likely magnitude or direction of coefficients (zero priors)”

  • The authors state this as an assumption.

    In the initial state of the world, services provided in a skin cancer or GP clinic have a 1-2 hour distraction from usual activities, greater than 95% chance of detecting a skin cancer, wait time of less than 4 hours for results, results reviewed by a GP, and 5 non-cancerous moles removed for every skin cancer detected.

    “We assume a 1-2 hour distraction from usual activities, greater than 95% chance of detecting a skin cancer if one is present, a wait time of less than 4 hours for results, that the results are reviewed by a GP, and that 5 non-cancerous moles are removed for every skin cancer detected for services provided in a skin cancer or GP clinic.”

  • The authors state this as an assumption.

    The teledermoscopy alternative assumes review by a dermatologist and that only 3 non-cancerous moles need to be removed to detect one skin cancer.

    “The introduction of a teledermoscopy alternative as an additional (fourth) screening mode, assumes review by a dermatologist and that only 3 non-cancerous moles need to be removed to detect one skin cancer.”

  • The authors state this as an assumption.

    Skin cancer clinics are staffed by GPs rather than dermatologists.

    “This estimate is also sensitive to the assumption that skin cancer clinics are staffed by GPs rather than dermatologists”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Store-and-forward teledermatology is well-accepted by patients and caregivers.

    “Store-and-forward teledermatology is well-accepted by patients and caregivers [59,69,70].”

    From Use of Smartphones for Early Detection of Melanoma: Systematic Review (2018) · cites this paper as [69]

    The Results (page unavailable) estimate a 0.668 probability of uptake for the teledermoscopy model, supporting potential consumer acceptance. But the Introduction (page unavailable) describes earlier satisfaction findings as mixed, and the paper does not establish that store-and-forward teledermatology is well accepted by caregivers. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Initial skin cancer clinic uptake differs from Table 5

    Minor

    The text reports an initial uptake probability of 0.548 for skin cancer clinic screening, but Table 5 reports 0.553 for the three-alternative scenario.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Queensland Cancer Registry, 2013, Cancer in Queensland: Incidence, mortality, survival and prevelance 1982–2011
  2. Non-melanoma Skin Cancer Working Group, 2003, The 2002 national non-melanoma cancer survey
  3. Hensher DA, 1994, Transportation (1986–1998), 21, 107

Cited by

Sorted by citations

Related

Authors
Spinks, J., Janda, M., Soyer, H. P., & Whitty, J. A.
Affiliations
  • Griffith University (AU)
  • Queensland University of Technology (AU)
  • Translational Research Institute (AU)
  • The University of Queensland (AU)
Corresponding author
Spinks, Jean
ORCID
Venue
Journal of Telemedicine and Telecare
Publisher
SAGE Publications
Published
2015-05-29
Volume
22
Issue
1
Pages
39-46
ISSN
  • 1357-633X (ISSN-L)
  • 1758-1109
DOI
10.1177/1357633x15586701
OpenAlex
W1546830067
Cited by
61
References
31
Citations by year
2025: 6 · 2024: 3 · 2023: 5 · 2022: 10 · 2021: 8 · 2020: 7 · 2019: 5 · 2018: 9 · 2017: 4 · 2016: 4
FWCI
2.46
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Telemedicine and Telecare (publishedVersion)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
  • Griffith Research Online (submittedVersion)
Funders
  • Griffith University
  • Menzies Health Institute Queensland
  • Medical Research Council
  • National Health and Medical Research Council (1045247, 1061183)
Topics
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
Keywords
teledermoscopy, melanoma screening, consumer preferences, willingness to pay, skin self-examination, store-and-forward telemedicine, skin cancer risk, early cancer detection, screening acceptability
MeSH terms
Consumer Behavior, Female, Humans, Male, Melanoma, Middle Aged, Queensland, Skin Neoplasms, Information Storage and Retrieval, Telemedicine, Dermoscopy, Early Detection of Cancer, Patient Preference

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