Aim: To assess the perception of telehealth visits among a multiracial cancer population during the coronavirus disease 2019 pandemic. Methods: This cross-sectional study was conducted at outpatient cancer clinics in Hawaii between March and August 2020. Patients were invited to participate in the survey either by phone or email. Results: Of the 212 survey respondents, 61.3% were Asian, 23.6% were White and 15.1% were Native Hawaiians or Pacific Islanders. Asians, Native Hawaiians and Pacific Islanders were less likely to desire future telehealth visits compared with Whites. Predictors with regard to preferring future telehealth visits included lower income and hematopoietic cancers. Conclusion: The authors found racial differences in preference for telehealth. Future studies aimed at overcoming these racial disparities are needed to provide equitable oncology care.
Background Telehealth visits increase patients’ access to care and are often rated as “just as good” as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. Objective Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. Methods We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. Results Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree “[y]our physician listened carefully to you”). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. Conclusions Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.
BACKGROUND Telehealth services are becoming increasingly more common in the care of oncology patients since the advent of the COVID-19 pandemic. However, it is not known if patient-physician communication via telehealth is equally effective among all racial groups. OBJECTIVE The objective of this study was to compare patient satisfaction with communication during telehealth versus face-to-face visits among oncology patients with a specific focus on Asian and Native Hawaiian and Other Pacific Islander (NHOPI) patients. METHODS We performed a cross-sectional study of a racially diverse group of cancer patients who had experienced a face-to-face or telehealth visit. Questions assessing satisfaction with patient-physician communication were adapted from a previously published study of a racially diverse population of cancer patients. Variables impacting communication included age, sex, household income, education level, and cancer type and stage were captured. Multivariable logistic models for patient satisfaction were created with adjustments for sociodemographic factors. RESULTS There were a total of 593 participants, 362 in the face-to-face group and 231 in the telehealth group. Racial distribution of the population was 24% White, 58% Asian, 13% NHOPI, and 5% other. Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those who underwent a telehealth encounter. Lower levels of satisfaction during telehealth visits were demonstrated among Asian and NHOPI participants compared to Whites even after adjusting for sociodemographic factors. For example, degree of agreement with the statement, “Your physician listened carefully to you” was significantly lower among both Asians (OR 0.27, 95% CI 0.12 to 0.62) and NHOPI (OR 0.20, 95% CI 0.08 to 0.57) patients. Importantly, there were no significant racial differences in communication during face-to-face visits. CONCLUSIONS Asian and NHOPI patients were significantly less content with patient-physician communication during telehealth visits than White patients. This difference between racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparity in healthcare satisfaction should prompt further exploration.
We investigated motor control strategies utilized by individuals with recurrent low back pain (rLBP) during active pain and remission periods as well as by back-healthy controls using the Balance-Dexterity Task. Nineteen young adults with rLBP were tested first when they were in pain and then again in symptom remission, and 19 matched controls were also tested. Trunk kinematic coupling and muscle co-activation were examined while participants performed the task by standing on one leg while compressing a spring with a maximum consistent force with the other leg. We found a decreased bilateral external oblique co-activation and a further reduced trunk coupling during the spring condition of the task compared to in a stable block condition in people with rLBP compared to back-healthy individuals. When individuals were in active pain, they exhibited more co-activation than when they were in remission, but the co-activation was not greater than in back-healthy individuals.
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