Evaluation of telemedicine practices during the COVID-19 pandemic for oncology patients

May 2021 Health Innovation Tobias Rawson

The interest in the use of telemedicine had a boost during the COVID-19 pandemic. Assessing this consultation modality in an oncological setting, the Tel Aviv Medical Center found that out of the 172 patients who received a telemedicine consultation, 93% reported that their concerns were adequately addressed. In fact, more than four out of five patients indicated that they would consider a telemedicine consultation again in the future.

Expert opinion

“Implementation of telemedicine opens a lot of possibilities, that go much further than simple tele-consultation. In fact, tele-radiology, tele-pathology and multidisciplinary discussion with teleconference were already in development long before the COVID-19 pandemic. The use of tele-consultation especially requires a selection of indications for optimal use. Short follow-up during active treatment has advantages and this can be done using teleconsultations. In contrast, however, intake of new patients and difficult discussion about bad news or end of life require a face-to-face discussion. Importantly, the article mentioned that 23% of respondents encountered technical difficulties, which is substantial in this, already selected, population. Although tele-consultation seems promising, human resources and technological barriers must be addressed to realize its full impact on cancer care.”

Introduction

Telemedicine practices, such as video calls, are an emerging consultation modality within primary care settings. With the ongoing COVID-19 pandemic however, telemedicine is being increasingly applied to other care settings, including secondary care Oncology. Given the fact that Oncology patients can be immunocompromised, telemedicine enables these patients to forego a hospital visit, thereby decreasing the risk of COVID-19 infection. However, there are concerns that this may compromise patient-physician interaction and patient confidentiality. Evaluating these concerns, and the impact of telemedicine practices, the Oncology Division at Tel Aviv Medical Center, Israel distributed patient satisfaction questionnaires to 172 Oncology patients who received at least one telemedicine consultation. The questionnaire focused on demographic information, previous mode of arrival to hospital, user interface, patient-physician interaction in relation to their previous in-person visit and the physician’s epithetical approach.

84% of patients would consider continuation of telemedicine

The median age of responders was 63, with 54% being male. The most common cancer diagnosis was gastrointestinal (N= 79, 46%), followed by genitourinary (N= 30, 17.4%), breast (N= 25, 14.5%) and lung cancer (N= 15, 8.4%). The majority of patients (N= 144, 83.2%) had received just one telemedicine consultation before the survey. Family or friends were present during 47% of telemedicine consultations (N= 82), whilst 52.3% (N= 90) received their consultation unaccompanied. The majority of patients felt that their medical records were accessible to the physician (N= 168, 97%), and that they were able to appropriately convey their physical and mental state (N= 168, 97%). Furthermore, the majority of patients felt that physicians’ explanations and treatment plans were clearly outlined (N= 162, 91%). An overwhelming majority of patients also reported a sense of security/privacy (N= 171, 99%). Most patients were satisfied with the physician’s attentiveness (N= 166, 96%) and said that they received adequate eye contact (N= 156, 90%). Ultimately, the majority of patients felt that their needs were accounted for (N= 146, 82%) as well as their concerns (N= 166, 93%). However, 20% (N= 36) felt that not having an in-person consultation harmed their treatment.

As a result of these telemedicine consultations, 84.4% reported that they would be interested in continuing this format in the future. Reasons for patients wanting to continue included shorter absolute travel time to hospital (N= 73, 42%), a sense of a safer home environment (N= 64, 37%), reduced risk of COVID-19 infection (N= 64, 37%), other infections (N= 46, 26%), reduced expenses (N= 29, 16.8%) and affirmation that their medical treatment was not compromised (N= 46, 26%). There was no statistical correlation between the purpose of the consultation and willingness to continue telemedicine practices in the future (P= 0.12). Additionally, there was also no correlation between the presence of family/friends and the willingness to continue telemedicine practices (P= 0.51). Furthermore, there was no significant correlation between willingness to continue and age (P= 0.31), gender (P= 0.67), profession (P= 0.71), education level (P= 0.69) and direct eye contact during consultation (P= 0.98). Conversely, patients who were satisfied that their concerns were addressed during the consultation were more likely to express interest in continuing telemedicine consultations (odds ratio [OR]: 2.41, P= 0.01). Patients who received a telemedicine consultation during routine surveillance after completing their oncology treatment plan were also more likely to continue using a telemedicine platform, compared to patients who received a telemedicine consultation upon their first oncology meeting (OR: 3.34, P= 0.03).  

Reference:

Hasson S et al., Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer. The Oncologist. 2021. [epub]. 

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