Abstract Background: Despite the rise in the occurrence of skin cancer, primary care nurse practitioners are reluctant to perform skin cancer assessments during patient visits. Melanoma is almost always curable if detected in the early stages, but invasive disease accounts for 9,000 deaths per year (American Cancer Society, 2013). Changing knowledge, attitudes and practice regarding skin cancer assessments potentially leads to early detection and treatment of skin cancers and impacts patient outcomes. However, in order to change knowledge and attitudes, we must first assess them. Purpose: The purpose of this research was to validate a new skin cancer assessment tool instrument called KAP-SCA to measure knowledge, attitude, and practice in primary care NPs. Methods: Sequential mixed methods were used. First, focus group interviews with 14 primary care nurse practitioners were conducted during Phase I. Interviews were audio-recorded then transcribed verbatim and imported into ATLAS.ti. Phase II involved instrument development from a blueprint and calculation of content validity indexes (CVI) for items and subscales. Phase III of this study included testing the validity and reliability of a KAP instrument using quantitative methods. This new instrument assesses primary care nurse practitioner knowledge, attitudes, and practice regarding skin cancer assessment. Results: Content validity for the subscales was evaluated by CVI ranged from .90 to .95. The Cronbach's alpha was highest for the practice subscale (alpha =.89) while the lowest was seen with the knowledge subscales (alpha =.50). Construct validity assessed by exploratory factor analysis indicated the presence of three underlying factors, confidence in practice, confidence relating to education and NP role in practice. Implications for Practice: Interventions need to be developed based on the knowledge deficits and barriers to practice identified by these NPs including educational programs that focus on increasing primary care NPs' knowledge and confidence levels regarding skin cancer assessments and identification of malignant lesions. Conclusion: Beginning evidence of validity and reliability were found for the Knowledge, Attitudes and Practice-Skin Cancer Assessments (KAP-SCA), however further studies are warranted.

Background: Skin cancer is the most commonly diagnosed cancer each year in the United States. With skin cancer and the demand for nurse practitioners (NPs) in primary care both on the rise, an accurate assessment of how well NP students are being prepared to perform skin cancer assessments is needed. Patient outcomes are directly linked to early detection and treatment which is essential for all types of skin cancer, especially melanoma. Nurse Practitioners need to be able to recognize the early stages of malignancy versus benign skin lesions and perform accurate skin examinations. The ability to assess practitioners’ knowledge while they are still students will give us a better understanding of how well they are being prepared to perform skin cancer assessments in primary practice. This information will inform educators where improvement in skin cancer education is needed. Methodology: Following IRB approval, nurse practitioner students enrolled in a gerontology course fall 2016 were invited to participate in this exploratory, descriptive study. Twenty NP students completed the Knowledge, Attitudes and Practice of Skin Cancer Assessments (KAP-SCA) survey. The survey has 80 questions about lesion identification, knowledge of general skin facts, education in NP Program, and knowledge, attitudes, and confidence levels during skin care assessments. Descriptive statistics (frequencies and percentages) were used to analyze demographics. Total scores and subscale scores for the KAP-SCA instrument were examined with descriptive statistics. Spearman’s Rho statistics were used for correlations among knowledge, attitude, training and practice. Results: The typical NP student was female, age 31 years and enrolled in the family nurse practitioner program at UCF. The majority of NP students had an average knowledge score for general skin cancer knowledge and photo lesion identification questions. However, the majority (70%) of NP students did not agree that the dermatology training they received in their NP program prepared them for practice. Discussion: Most NP students do not feel confident performing skin cancer assessments and basic dermatology procedures upon graduation. Most NP students had a difficult time differentiating between benign and malignant lesions, and would refer the patient to a specialist due to their lack of knowledge or confidence in diagnosis. Conclusions: Information obtained from the KAP-SCA survey demonstrated that the majority of NP students lacked confidence performing skin cancer assessments and had difficulty recognizing if a lesion was benign or malignant. This information can be helpful in informing educators on where improvement in skin cancer education is needed in NP programs.