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Lookup NU author(s): Dr Kirby Sainsbury
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.Background Poor adherence to photoprotection in xeroderma pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers. Objectives To test a highly personalized intervention (XPAND) to reduce the dose of ultraviolet radiation (UVR) reaching the face in adults with XP, designed using known psychosocial determinants of poor photoprotection. Methods A two-arm parallel group randomized controlled trial, including patients with suboptimal photoprotection to receive XPAND or a delayed-intervention control arm that received XPAND the following year. XPAND comprises seven 1 : 1 sessions targeting photoprotection barriers (e.g. misconceptions about UVR) supported by personalized text messages, activity sheets and educational materials incorporating behaviour change techniques. The primary outcome, mean daily UVR dose to face across 21 days in June–July 2018, was calculated by combining UVR exposure at the wrist with a face photoprotection activity diary. Secondary outcomes were UVR dose to face across 21 days in August 2018, time spent outside, photoprotective measures used outside, mood, automaticity and confidence to photoprotect. Financial costs and quality-adjusted life years (QALYs) were calculated. Results Sixteen patients were randomized; 13 provided sufficient data for primary outcome analysis. The XPAND group (n = 8) had lower mean daily UVR dose to face [0.03 standard error of difference (SED) (SD 0.02)] compared with controls (n = 7) [0.43 SED (SD 0.17)] (adjusted difference = –0.25, P < 0.001, Hedge’s g = 2.21) at the June 2018 assessment. No significant between-group differences were observed in time spent outside, photoprotection outside, mood or confidence. The delayed-intervention control showed improvements in UVR dose to face (adjusted difference = –0.05; Hedge’s g = –0.1), time outside (adjusted difference = –69.9; Hedge’s g = –0.28) and photoprotection (adjusted difference = –0.23, Hedge’s g = 0.45) after receiving XPAND (June 2019 assessment). XPAND was associated with lower treatment costs [–£2642; 95% confidence interval (CI) –£8715 to £3873] and fewer QALYs (–0.0141; 95% CI –0.0369 to 0.0028). Conclusions XPAND was associated with a lower UVR dose to face in patients with XP and was cost-effective.
Author(s): Walburn J, Norton S, Sarkany R, Canfield M, Sainsbury K, McCrone P, Araujo-Soares V, Morgan M, Boadu J, Foster L, Heydenreich J, Mander AP, Sniehotta FF, Wulf HC, Weinman J
Publication type: Article
Publication status: Published
Journal: British Journal of Dermatology
Year: 2025
Volume: 192
Issue: 4
Pages: 728-737
Print publication date: 01/04/2025
Online publication date: 15/10/2024
Acceptance date: 07/10/2024
Date deposited: 08/04/2025
ISSN (print): 0007-0963
ISSN (electronic): 1365-2133
Publisher: Oxford University Press
URL: https://doi.org/10.1093/bjd/ljae393
DOI: 10.1093/bjd/ljae393
Data Access Statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions
PubMed id: 39401796
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