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Behavioral Counseling Recommendations for Skin Cancer Prevention

Behavioral Counseling Recommendations for Skin Cancer Prevention

In the March 20, 2018 issue of the Journal of the American Medical Association, the U.S. Preventive Services Task Force (USPSTF) published a recommendation statement on behavioral counseling to prevent skin cancer.

The publication updated the 2012 USPSTF recommendation on behavioral counseling for the prevention of skin cancer.

The USPSTF determined that behavioral counseling interventions are of moderate benefit in increasing sun protection behaviors in children, adolescents, and young adults with fair skin types (aged 6 months to 24 years old). They found adequate evidence that behavioral counseling interventions result in a small increase in sun protection behaviors in adults older than 24 years with fair skin types.

The USPSTF, however, found inadequate evidence on the benefits and harms of counseling adults about skin self-examination to prevent skin cancer. This conclusion was based on the lack of evidence that skin self-examination is beneficial.

Two editorials  – one led by Dr. June Robinson from the Department of Dermatology at the Northwestern University Feinberg School of Medicine in Chicago and the other led by Dr. David Buller, Director of Research at Klein Buendel –  were also published along with the Task Force recommendations.

The editorial by Robinson and Jablonski points out that while physicians are trusted sources of health information, people at risk for skin cancer or with a family history of skin cancer may also find family members to be useful networks for information on prevention and self-examination.

The editorial by Buller, Heckman, and Manne expresses disappointment in the Task Force not recommending skin self-examination and points out that some ongoing studies to determine effectiveness of skin self-examination may find that it is effective.

Both editorials describe the Task Force’s definition of risk as “fair skin types” as narrow. They believe that many other people are at risk for skin cancer and could benefit from sun protection education and counseling. Some groups mentioned in the editorials include people who sunburn but are not considered fair-skinned, people who use indoor tanning equipment, children and adolescents, Hispanics, and people who are physically active outdoors. According to the authors, it is important not to disenfranchise these groups within the diverse U.S. population.

A Randomized Study of Shade Sails and Passive Recreation in Public Parks in Two Hemispheres

A Randomized Study of Shade Sails and Passive Recreation in Public Parks in Two Hemispheres

Skin cancer is the most common type of cancer1 but the primary risk factor for skin cancer, UV exposure, is the most avoidable.2 Purpose-built shade not only reduces UV exposure,3 it can also come with other benefits like provide protection without requiring planning4 and may even provide protection for individuals with negative attitudes towards sun safety who seek shade to keep cool.5

In a recent publication in American Journal of Public Health, KB’s Dr. David Buller, Mary Buller and collaborators in Australia, at the University of Melbourne (Dr. Dallas English) and Cancer Council Victoria, (Dr. Suzanne Dobbinson) conducted a stratified randomized study in Melbourne, Australia and Denver, Colorado where shade sails were built in 1 of 2 passive recreation areas (PRAs) in full sun in 144 parks (71 in Melbourne and 73 in Denver). The use of the PRAs with shade sails built as part of the study were compared with the nearby non-shaded PRAs for use by park visitors. The authors tested two hypotheses – the first being that the introduction of shade sails over PRAs would increase the use of these PRAs by visitors compared to unshaded PRAs – and the second being that the increase in use of shaded PRAs would be larger in Melbourne, Australia than Denver, Colorado due to stronger norms for sun safety in Australia than the United States.

Public parks enrolled in the study had to contain at least two unshaded PRAs that were in full sun at pretest, and one of the two PRAs had to contain a space where a shade sail could be constructed. Trained observers made observations at the PRAs for 30-minute periods on four weekend days during a 20-week period in the summer months for each city at pretest and posttest to determine the number of visitors during peak UV hours (11 am to 3 pm). Shade sails were designed to be attractive while also providing shade during peak UV times and the shade cloth selected reduced UV by at least 94%. …

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Sun Safe Policies in Elementary Schools

Sun Safe Policies in Elementary Schools

School policies that improve sun safety for children are essential to comprehensive school-based skin cancer prevention. California was one of the first states that enacted legislation governing sun protection for students in public schools. In a research letter recently published in JAMA Dermatology, KB’s Julia Berteletti, Dr. David Buller and Lucia Liu along with collaborators at Claremont Graduate University and the non-profit organization, Sun Safety for Kids, looked at how elementary schools in California adopted a policy for sun safety as recommended by the California School Boards Association (CSBA), a nonprofit membership-based education association representing elected officials who govern public school districts.

The Sample Policy, created through a collaboration with CSBA during a previous study, was based on sun safety recommendations put forth by California law and the Centers for Disease Control and Prevention recommendations and was disseminated to member school districts. The authors examined the content of sun safety policies for any deviation from the Sample Policy for 190 member districts that included elementary schools, subscribed to CSBA policy services, and posted their Board Policy online. The sun safety content of the Sample Policy and each districts’ sun safety policy was coded in 11 categories, such as sunscreen use, UV protective clothing, student education, and shade provision. Each policy was scored on content per category, strength of action specified, and intent for sun protection.

The majority of policies addressed sunscreen, protective clothing and hats. Most included shade, scheduling of outdoor activities to avoid peak UV hours, staff modeling and parent outreach. 75% of policies included student education. Educating teachers, resource allocation, and accountability were addressed in almost no policies. Also, 40% of districts altered their own policy to remove some content from the CSBA Sample Policy. The most frequently removed items were student education, outdoor shade or parent outreach. Authors also found that districts that removed content had significantly more students and administrators than those that adopted the Sample Policy verbatim.

Authors concluded that the CSBA played an influential role in the school districts’ adoption of sun safety policy and suggest that establishing a partnership with a similar association could be an important part of achieving school-based skin cancer prevention.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University and Dr. David Buller, KB, Principal Investigators).

KB to Co-Host International UV Conference May 1-4, 2018

KB to Co-Host International UV Conference May 1-4, 2018

Klein Buendel is a proud North American organizer and host of the 4th International Conference on UV and Skin Cancer Prevention being held May 1-4, 2018 in Toronto, Canada. The 2018 conference is being organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association, and Klein Buendel.

The UV and Skin Cancer Prevention conferences provide an innovative scientific program that showcases the work of the international skin cancer prevention community. The previous conferences have been held in Copenhagen, Denmark (2011), Berlin, Germany (2013), and Melbourne, Australia (2015) and have attracted international experts in skin cancer prevention, UV radiation science, dermatology, allied behavioral and clinical disciplines and members of the environmental planning and design communities who are working in the field of UV and skin cancer prevention. The conferences have been organized by local planning committees dedicated to advancing skin cancer prevention.

The Toronto conference will feature multiple concurrent sessions and poster sessions addressing primary and secondary prevention, school settings, worksites, shade design, sun safety campaigns, indoor tanning trends, sunscreen, and more.

Special plenary sessions will address:

  • New Research Methods for Skin Cancer Prevention
  • Issues in Dissemination of Skin Cancer Prevention Interventions
  • Second Generation Audiences for Skin Cancer Prevention
  • Environmental Issues in Skin Cancer Prevention
  • Screening for Skin Cancer Prevention

Four additional workshops will be held on May 1st:

  • Sun Safety and Skin Health in Youth
  • Young Adulthood Physical Activity
  • Skin Smart Campus
  • Online, Mobile, and Social Media Interventions

To see the program-at-a-glance, speakers, and registration information, visit…

4th International Conference on UV and Skin Cancer Prevention

 

Expressing Empathy: Part 3

Expressing Empathy: Part 3

Tips for Showing Empathy: Strategies for Becoming More Empathic

Nonverbal Communication

  • Listen to what is not being said. Pay attention to the nonverbal cues being sent by you and the other person.
  • Face the person. Keep your body posture relaxed and open. Lean toward the person.
  • Maintain eye contact. Mimic their facial expressions –be careful that your expression is not blank or frowning.
  • Physical contact, such as a hug or touching the person’s arm, may be helpful.
  • Recognize what you are feeling, especially negative feelings.

Verbal Communication

What to Say:

  • If possible, talk in a place that is comfortable and will have minimal interruptions.
  • Allow the person to talk uninterrupted.
  • Ask open-ended questions. This lets the person know that you’re willing to listen. Example – How are you doing with this? Would it help to talk about this? Is there something troubling you? What are you feeling?
  • Use a pleasant tone of voice.
  • Statements you might say:
    • “You seem worried.”
    • “I see why you are concerned about this.”
    • “Tell me more about what is worrying you.”
    • “I will be here for you.”
    • “It sounds like you are feeling…(fill in the blank).”

What Not to Say:

  • Do not try to fix the problem, interpret or analyze what is happening, or argue.
  • Do not preach, lecture, judge, blame or criticize. Avoid saying “should” or “ought to.”
  • Do not minimize their fears by saying, “It will be fine” or “you’ll be OK” or “at least it isn’t…”

Communicating About Cancer Series Info

This research project was funded by a grant from the National Cancer Institute (CA144235; Dr. Wayne Beach, San Diego State University, Principal Investigator). Co-investigators included Dr. David Dozier from San Diego State University, and Mary Buller, Dr. Valerie Myers, and Dr. David Buller from Klein Buendel, Inc.

Expressing Empathy: Part 2

Expressing Empathy: Part 2

Empathy in Patient/Doctor Relationships

*Names have been changed to protect privacy.*

Carl Patterson was with his elderly stepfather when he died from acute lymphatic leukemia. Tom had been a laid-back, easy going man who made friends easily and preferred to have a glass of wine than worry about small details. Carl, on the other hand, was detail-oriented and had been looking after his stepfather’s affairs for years.

Tom wanted to donate his body to a local university for medical research. In most cases, if a body is not received promptly after death, research organizations will refuse the donation. Carl knew this. So he grew impatient when hours passed after his stepfather died and the doctor, who needed to process the paperwork to release Tom’s body, didn’t appear. Carl repeatedly questioned the nurses. The nurses repeatedly paged the doctor. When she arrived, the doctor told Carl, “I have more important things to do with the living than with the dead.” Carl was stunned. “He had just died,” he said. “Her bedside manner didn’t exist.”

Numerous studies have found that empathy is often missing in doctor-patient communication. Expressing empathy can be even more difficult in situations involving conflict, anger, sadness or fear. These feelings are common on a cancer journey.  When medical professionals show empathy, patients feel more satisfied with the relationship. They also have more trust in their doctor, are less anxious about their condition, and are more likely to follow the doctor’s recommendations. Doctors feel better about their work too. Empathy is a learnable skill being taught more frequently in medical schools to help improve patient-doctor communication. …

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Expressing Empathy: Part 1

Expressing Empathy: Part 1

“Empathy is really the opposite of spiritual meanness. It’s the capacity to understand that every war is both won and lost. And that someone else’s pain is as meaningful as your own.” – Barbara Kingsolver, author.

Katrine Bellamy thinks this story is funny. It’s the story of how people sometimes react when they hear about cancer. Katrine and her neighbor took turns walking the kids to and from school. But, on the day she learned her 9-year-old son had a brain tumor, she asked her neighbor to pick up the children. When Katrine arrived home, she saw her neighbor standing in the driveway, waiting for her. “She literally collapsed in my arms,” said Katrine. The distraught women cried as Katrine reassured her that everything would be alright. Katrine needed a friend who would listen. She ended up helping her friends cope with the news instead.

This is an article about empathy. It is easy to misunderstand the difference between sympathy and empathy. When you have sympathy you have compassion for another person and acknowledge their hardship. Empathy is when you understand and feel another person’s feelings for yourself; it is a mutual experience of feeling. With empathy you “put yourself in their shoes.” …

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Conflict Management: Part 2

Conflict Management: Part 2

Strategies for Resolving Conflict

Coping with cancer, either as a patient, family member, friend, or medical provider can be very difficult. Stress levels are higher. Everyone involved can have less patience and be more sensitive to problems and issues. Common situations that might normally blow over can explode into a major argument instead. If you experience a conflict with another person, experts suggest using the following strategies:

  1. Identify the cause of the conflict. Get to the root of the problem, and then deal with the cause. Sometimes small conflicts are really about larger issues.
  2. Listen attentively and speak in a way that you can be clearly understood. Consider how you express yourself and disagree with others. Does the tone of your voice become accusing, snide, rude? Do you cross your arms, roll your eyes? Do you get defensive? What kind of pronouns do you use? Experts recommend using “I” instead of “you” during a conflict. For example, you might say, “When this happens, I feel unloved” instead of “When you do this, you cause problems.”
  3. Try to understand the other person’s position or perspective. Be open-minded so that everyone involved can talk openly about their different views. Consider the issue from the other person’s point of view.
  4. Take responsibility. Do you always blame others for problems? Conflict is two-sided. What common ground can you find?
  5. Set goals on which everyone can agree. Try not to dwell too much on what’s passed. Instead, focus on how to best move forward and what can be accomplished in the future.

Experts also recommend developing a plan for handling conflict in situations where disagreements might surface. For example, family gatherings during the holidays can be stressful. Think about how you might handle issues that come up. Or perhaps your hair has started falling out. People are bound to stare, ask questions, or make insensitive comments. How will you respond? Or, on the flip side, you know someone with cancer who is losing their hair. What should you say?

Settling conflicts requires communication that is respectful and empathetic. It helps if there is trust in the relationship. Also, a certain amount of self-disclosure might be necessary.

Communicating About Cancer Series

This research project was funded by a grant from the National Cancer Institute (CA144235; Dr. Wayne Beach, San Diego State University, Principal Investigator). Co-investigators included Dr. David Dozier from San Diego State University, and Mary Buller, Dr. Valerie Myers, and Dr. David Buller from Klein Buendel, Inc.

Conflict Management: Part 1

Conflict Management: Part 1

Managing Conflict

*Names have been changed to protect privacy.*

Just three days after his ninth birthday, Steven Bellamy’s mother, Katrine Bellamy, learned what she’d already strongly suspected. Earlier she’d called her son’s physician insisting she be told the results of Steven’s MRI. Not tomorrow. Not in three hours. Now. Instead, the doctor told her to immediately take Steven to the hospital. In tremendous pain, he was admitted to a room where he quickly fell asleep. Katrine spotted an envelope containing MRI images. She couldn’t help herself. She had to open it. Her husband, Dan, who thought she’d spent the past three weeks being overly paranoid about their son’s vomiting spells and headaches, told her to wait for the doctor. I can’t, she told him. I need to know now. Dan left the room, and Katrine pulled out the slides. The baseball-sized mass on Steven’s brain was impossible to miss. Katrine didn’t need a neurosurgeon to explain that she was looking at a brain tumor.

For the Bellamy’s, a long and difficult cancer journey had begun. Their story, like that of many others, includes episodes of conflict between themselves, other family members, friends and medical staff. This article is about conflict and how to manage it. If cancer is “The Big C,” conflict is the “Not-so-little C” that is almost always part of a cancer journey.

What is Conflict?

To put it simply, conflict is a disagreement. For anyone dealing with cancer, conflict can occur over something mundane like deciding what’s for dinner to more difficult decisions involving care. For example, Katrine and Dan had very different ideas about letting their nine-year-old son have a say in treatment decisions. All options sounded terrifying – some could mentally impair their son, others could kill him. When Katrine was pregnant, Dan said he didn’t think he could handle having a child with Down Syndrome. Now he had a child with cancer and was terrified. Dan wanted to present Steven with his options. Katrine said that it would be too much of a burden on their child. After much discussion, Katrine and Dan concluded that “This is our cross to bear. “ Steven would not participate in the decision-making process. As parents, the burden was theirs. They would make the decision and “live with the consequences.”

An equally agonizing conflict occurred with the care of George Janosik, who had been diagnosed with terminal cancer. Janosik’s siblings and in-laws shared caregiving responsibilities which included giving him morphine to ease his excruciating pain. Janosik pleaded for a lethal dose. The caregivers were torn. Some felt it was cruel to let him suffer. For others, self-assisted suicide violated their religious beliefs. It was also against the law. No decision was ever made. Soon after, Janosik died.

These examples highlight how conflicts can emerge due to differences of opinion, beliefs, and communication style. In addition, personal values, stress, distrust, misunderstandings, personality clashes, and power struggles are common sources of disagreements. …

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Managing Emotions: Part 1

Managing Emotions: Part 1

Riding Cancer’s Emotional Roller Coaster

*Names have been changed to protect privacy.*

Anyone who begins a cancer journey is likely to step onto a rollercoaster of strong emotions that can vary dramatically from point to point along the way.  Patients, family members, and friends will experience many different feelings ranging from frustration and powerlessness to joy and affection after a cancer diagnosis.

Emotion can be thought of as the “bedrock” of the communication skills. How a person feels and how they control those feelings will affect how they deal with conflict, what they disclose and their level of respect, trust, and empathy for others. This article looks at the role of emotions and provides tips on how to manage feelings to better cope with cancer.

Emotions on a Cancer Journey

San Diego resident Tim Hayes had a lot on his plate when he received his testicular cancer diagnosis.  A 37-year-old college professor with a full work schedule, he had custody of his two young children, and a summer teaching session planned in Africa over the summer.

However, near the end of spring semester, strong abdominal pains made him visit his doctor, who gave him several medical tests.  Before the results came back, Tim traveled to Canada for a professional conference. But he felt miserable. He couldn’t eat. He was exhausted. He spent much of the conference sleeping in his hotel room, which is where his doctor tracked him down.

“My doctor told me one long Latin word, then another,” he said. Decoded, the Latin words meant cancer.

Tim asked if the diagnosis would interfere with his summer teaching plans. It would. He was told he needed immediate surgery, followed by chemotherapy and radiation treatment.

This kind of news would completely devastate some people. Others might be paralyzed by fear. Tim, however, immediately began planning for the future – a future he believed would be cancer free. He tied up loose ends, spent more time with his kids, and was determined to be healthy enough to teach again in the fall.

“It was symbolic of beating the cancer – that’s how I spent my summer vacation, but I’d be back to work in the fall,” Tim said.

Tim took a very practical approach to dealing with his cancer and maintained a positive attitude.  Not everyone would react this way. Emotions play a significant role in how individuals interpret a situation and resolve it. Emotions also influence a person’s attitude and behavior. …

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