Co-design of a decision aid for the management of lentigo maligna in older and frailer adults

Karponis, Dimitrios, Cardamone, Elisa, Mistry, Khaylen, Halliday, Frank, Patel, Martyn, Levell, Nick, Stratigos, Alexander, Nikolaou, Vasiliki and Venables, Zoe (2026) Co-design of a decision aid for the management of lentigo maligna in older and frailer adults. Skin Health and Disease. ISSN 2690-442X

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Abstract

Background: Lentigo maligna (LM) can be treated surgically, topically using imiquimod, or simply observed. The risk of progression to melanoma is considered low. There is clinical equipoise on management in older or frail adults, with no decision aids available for managing LM in this group. Objectives: To co-design a patient decision aid (PDA) for the management of LM in older or frail adults. Methods: The PDA was targeted at patients at least 85 years old, or those aged 75–84 years with a Rockwood Clinical Frailty Score of at least 4. Semi-structured interviews were conducted with patients and healthcare practitioners (HCPs) to co-design the tool. Thematic analysis was performed using NVivo 14. The prototype was tested via structured interviews with patients and HCPs, and amended in an iterative process until saturation was achieved. Results: In total, 13 patients and 18 HCPs were interviewed to co-design the prototype. Alpha-testing resulted in saturation after 20 iterations. The following key themes (and subthemes) were identified Theme 1: fear of cancer (definition of LM; risk of progression; prognosis); Theme 2: burden of treatment (risks, side effects and delays in treatment; likelihood of recurrence; frequency of follow-up; impact on quality of life); Theme 3: partnership and shared decision-making (empowering patients; involving family and carers; burden of responsibility); and Theme 4: information overload (less is more; accessibility). Conclusions: This is the first PDA for the management of LM in older and frail patients. This co-designed, patient-centred tool may empower patients to participate in decision-making by better understanding LM and the available management options.

Item Type:	Article
Additional Information:	Data availability: The data underlying this article will be shared on reasonable request to the corresponding author, respecting patient confidentiality.
Uncontrolled Keywords:	sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health)
Depositing User:	LivePure Connector
Date Deposited:	27 Mar 2026 09:30
Last Modified:	31 Mar 2026 02:08
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102602
DOI:	10.1093/skinhd/vzaf118

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