A personalised and systematically designed adherence intervention improves photoprotection in adults with Xeroderma Pigmentosum (XP): Results of the XPAND randomised controlled trial

Walburn, Jessica, Norton, Sam, Sarkany, Robert, Canfield, Martha, Sainsbury, Kirby, McCrone, Paul, Araújo-Soares, Vera, Morgan, Myfanwy, Boadu, Janette, Foster, Lesley, Heydenreich, Jakob, Mander, Adrian P. ORCID: https://orcid.org/0000-0002-0742-9040, Sniehotta, Falko F., Wulf, Hans Christian and Weinman, John 2024. A personalised and systematically designed adherence intervention improves photoprotection in adults with Xeroderma Pigmentosum (XP): Results of the XPAND randomised controlled trial. British Journal of Dermatology , ljae393. 10.1093/bjd/ljae393

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Abstract

Background: Poor adherence to photoprotection in Xeroderma Pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers. Objective: To test a highly personalised 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 randomised controlled trial, including patients with sub-optimal photoprotection to receive XPAND or a delayed intervention control arm that received XPAND the following year. XPAND comprises seven one-to-one sessions targeting photoprotection barriers (e.g., misconceptions about UVR) supported by personalised 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, confidence-to-photoprotect. Financial costs and quality-adjusted life years (QALYs) were calculated. Results: 16 patients were randomised, 13 provided sufficient data for primary outcome analysis. The XPAND group (n=8) had lower mean daily UVR dose-to-face [0.03 SED (SD 0.02] compared to control (n=7) [0.36 SED (SD 0.16)] (adjusted difference=-0.25, p<0.001, Hedge’s g=2.2). 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. XPAND was associated with lower treatment costs (£-2642; 95% 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 XP patients and was cost-effective.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Start Date: 2024-10-15
Publisher:	Oxford University Press
ISSN:	0007-0963
Date of First Compliant Deposit:	24 October 2024
Date of Acceptance:	11 October 2024
Last Modified:	07 Nov 2024 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/173302

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