Our findings reveal that family discussions about melanoma are guided by an implicit set of rules that determine what is discussed, when the conversations occur, as well as who is engaged.
Initiators of Family Discussions
Women tend to be the primary initiators of discussions about melanoma diagnosis, treatment, and prevention. Accordingly, the patient’s spouse, daughter, or female patients themselves often take the lead in discussing melanoma topics in the family. As such, women are likely to spread the word through the family system that there has been a melanoma diagnosis, and they are also most likely to follow through with recommending sun protection and physician screening to children, siblings, and other family members.
Facilitators and Barriers of Discussions
Disease, individual, and family-specific factors play a role in shaping discussions about melanoma. Patients who do not believe that their melanoma was caused by sun exposure or genetic factors see less of a need to discuss it.1
Patients who developed melanoma on a non–sun-exposed body site shared less about their disease and prevention, and discussions were more likely to occur when melanoma is perceived to “run in the family.” Those families who describe themselves as health conscious engage in more discussions. Patients often avoid discussions out of a desire to minimize fear about the disease occurring in the family and if they perceive that it is “not their place” to discuss prevention. Degree of closeness—emotional or geographical—also dictates whether and when discussions occur.
Content of Discussions
Families report that their discussions about melanoma evolve across time. At first, family conversations typically focus primarily on the patient, including diagnosis and the treatment planned. Family members often turn to the Internet during this time to supplement information learned from the patient or their physician; this is especially true when patients or family members have a desire to obtain information that is potentially upsetting. After the resolution of this acute treatment phase, conversations about family risk and prevention predominate. Discussion goals become firmly centered on avoiding recurrence in the patient or avoiding the illness in unaffected family members, particularly children. Discussion content included scare tactics as well as daily in-the-moment reminders about sun protection.
Targets of Melanoma Discussions
Family members report extensive deliberation concerning which family members are most at risk for melanoma, and these family members are singled out for more intensive family conversations about prevention. Discussion targets include blood relatives, relatives with stronger perceived genetic susceptibility, those with lighter skin, those whose severe sunburns are vividly remembered, and those who currently sunbathe and use tanning salons.