Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

Summary

Background

The increasing incidence of actinic keratosis (AK) is causing a large burden on health care systems. The current management of AK patients seems to vary within and between primary and secondary care; however, an in‐depth understanding of healthcare providers' management of AK is currently lacking.

Objective

To gain insight into the management of AK by exploring underlying motives of current practices among general practitioners (GPs) and dermatologists in The Netherlands.

Methods

A qualitative study was conducted consisting of semi‐structured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim, and inductively analysed by two researchers drawing on elements of grounded theory.

Results

GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK, mainly applying cryotherapy or referral to secondary care due to lack of experience, varying in their applications and providing mostly patient‐driven follow‐up care; they also reported a high need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated to pursue proactive clinical assessments of cutaneous photodamage and the goal of providing guideline‐driven AK care. Patient preferences, though, still largely influence both treatment choices and follow‐up regimens. Furthermore, dermatologists reported the need for improving AK and skin cancer management in primary care.

Conclusions

For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.

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