IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. OBJECTIVE To examine the outcomes of a cancer center-wide virtual care program in response to the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. MAIN OUTCOMES AND MEASURES Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. RESULTS The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. CONCLUSIONS AND RELEVANCE These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.

There has been longstanding interest in virtual care in oncology, but outdated reimbursement structures and a paradoxical lack of agility within electronic systems limited widespread adoption. Through the example of the Province of Ontario, Canada and the Princess Margaret Cancer Centre, we describe how a collective sense of action from COVID-19, a system of distributed leadership and decision-making, and the use of a Service Design process to map the ambulatory encounter onto a digital workflow were critical enablers of a large-scale virtual transition. Rigorous evaluation of virtual care models will be essential to maintain integration of virtual care post-pandemic.

Introduction Digital health tools may be effective in engaging solid organ transplant (SOT) recipients in physical activity (PA). This study examined the perspectives of SOT recipients regarding PA, and desired features for digital health tools. Methods Semi‐structured interviews were used to explore perspectives of SOT recipients about barriers and motivators to physical activity, and core features of a digital health tool to support PA. Interviews were analyzed via thematic analysis. Results Participants included 21 SOT recipients (11 men, 10 women, 21‐78 years, 1.5‐16 years post‐transplant) from various organ groups (four heart, five kidney, five liver, three lung, and four multi‐organ). Barriers to PA included risk aversion, managing non‐linear health trajectories, physical limitations and lack of access to appropriate fitness training. Facilitators of PA included desire to live long and healthy lives, renewed physical capabilities, access to appropriate fitness guidelines and facilities. Desired features of a digital health tool included a reward system, affordability, integration of multiple functions, and the ability to selectively share information with healthcare professionals and peers. Conclusions SOT recipients identified the desired features of a digital health tool, which may be incorporated into future designs of digital and mobile health applications to support PA in SOT recipients.

IntroductionMore women experience cardiac pain related to coronary artery disease and cardiac procedures compared with men. The overall goal of this programme of research is to develop an integrated smartphone and web-based intervention (HEARTPA♀N) to help women recognise and self-manage cardiac pain.Methods and analysisThis protocol outlines the mixed methods strategy used for the development of the HEARTPA♀N content/core feature set (phase 2A), usability testing (phase 2B) and evaluation with a pilot randomised controlled trial (RCT) (phase 3). We are using the individual and family self-management theory, mobile device functionality and pervasive information architecture of mHealth interventions, and following a sequential phased approach recommended by the Medical Research Council to develop HEARTPA♀N. The phase 3 pilot RCT will enable us to refine the prototype, inform the methodology and calculate the sample size for a larger multisite RCT (phase 4, future work). Patient partners have been actively involved in setting the HEARTPA♀N research agenda, including defining patient-reported outcome measures for the pilot RCT: pain and health-related quality of life (HRQoL). As such, the guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols (SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3). Quantitative data (eg, demographic and clinical information) will be summarised using descriptive statistics (phases 2AB and 3) and a content analysis will be used to identify themes (phase 2AB). A process evaluation will be used to assess the feasibility of the implementation of the intervention and a preliminary efficacy evaluation will be undertaken focusing on the outcomes of pain and HRQoL (phase 3).Ethics and disseminationEthics approval was obtained from the University of Toronto (36415; 26 November 2018). We will disseminate knowledge of HEARTPA♀N through publication, conference presentation and national public forums (Café Scientifique), and through fact sheets, tweets and webinars.Trial registration numberNCT03800082.

389 Background: The COVID-19 pandemic catalyzed rapid implementation of virtual care (VC), resulting in new opportunities to integrate technology and a need to evaluate patient and provider experiences. To inform sustainment beyond COVID-19, we evaluated perceptions of VC at a comprehensive cancer centre in Toronto, Canada. Methods: Physicians who provided VC during the pandemic, and patients with a valid email address on file and at least one visit with centre in the preceding 12 months were eligible to participate. Survey invitations were disseminated between May and July 2021 via email using a modified Dillman approach. The survey examined the implementation outcomes of acceptability, adoption, and appropriateness. Unadjusted associations between patient demographic variables and preference for in-person visits were evaluated using univariate logistic regression models. Results: 41% (100/246) of physicians and 15% (2,343/15,169) of patients completed the survey. The majority of patients were Caucasian (77%), college or university educated (78%), had solid malignancies (73%), and were in the follow-up phase (47%); 50% were male. The median age was 66 (IQR: 58-74). A greater proportion of patients expressed satisfaction with VC than providers (81% and 53%). Conversely, a greater proportion of providers felt that care delivered virtually was worse than care delivered in-person (45% vs 26%). Interestingly, many patients (69%) and physicians (40%) reported feeling they could maintain a good relationship through VC while at the same time reporting concerns that VC would detract from the human interaction they value as part of care (patients: 60%; providers: 82%). Patients expressed relatively equal preference for phone vs video visits (40% vs 31%), but indicated concerns about wait times for VC visits. The majority of physicians (37%) estimated that 10-29% of their practice would remain virtual post-COVID, however physicians expressed concerns with increased workload (72%), decreased efficiency (40%), and increased worry about missing relevant clinical information (61%). The majority of patients and physicians reported that VC was not appropriate for first consultations and discussions of prognosis, and most appropriate for long-term follow-up. Being born outside of Canada, primary language other than English, lower income, lower functional health literacy, and greater physical mobility were associated with preferring in-person over VC visits. Conclusions: Patients and physicians were satisfied with VC but expressed concerns with the impacts on care quality and experience and highlighted the need for guidelines on appropriate use. Providers expressed greater concerns with VC than patients. More research is needed to formally evaluate the impact of VC on quality performance and clinical outcomes as well as investigate the patient, disease and system factors that are associated with effective virtual cancer care.

Introduction: As we progress to an era when patient autonomy and shared decision-making are highly valued, there is a need to also have effective patient-centered communication tools. Radiology reports are designed for clinicians and can be very technical and difficult for patients to understand. It is important for patients to understand their magnetic resonance imaging (MRI) report in order to make an informed treatment decision with their physician. Therefore, we aimed to create a patient-centered prostate MRI report in order to give our patients a better understanding of their clinical condition. Methods: A prototype patient-centered radiology report (PACERR) was created by identifying items to include based on opinions sought from a group of patients undergoing prostate MRI and medical experts. Data was collected in semi-structured interviews using a salient belief question. A prototype PACERR was created in collaboration with human factors engineering and design, medical imaging, biomedical informatics, and cancer patient education groups. Results: Fifteen patients and eight experts from urology, radiation oncology, radiology, and nursing participated in this study. Patients were particularly interested to have a report with laymen terms, concise language, contextualization of values, definitions of medical terms, and next course of action. Everyone believed the report should include the risk of MRI findings actually being cancer in the subsequent biopsy. Conclusions: A prostate MRI PACERR has been developed to communicate the most important findings relevant to decision-making in prostate cancer using patient-oriented design principles. The ability of this tool to improve patient knowledge and communication will be explored.

Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) Physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.

e18768 Background: Virtual care (VC) and electronic patient-reported experience measures (ePREM) have been systemically adopted during the COVID-19 pandemic to facilitate continuity of cancer care and quality improvement. Digital divides, defined as differential access and benefit from these tools, may exacerbate existing health inequities among patients. We aimed to evaluate digital divides through ePREM access, use, and responses during the pandemic. Methods: Your Voice Matters (YVM), a provincially-mandated ePREM survey, was adapted to an online platform in September 2020 and emailed to patients after outpatient VC and in-person clinic visits at a tertiary cancer centre in Ontario. Age, gender, postal codes, and completed surveys from September-December 2020 were collated. Income was estimated using area-level averages from Statistics Canada 2016 census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation: residential instability (RI), economic dependency, ethnocultural composition (EC), situational vulnerability (SV). Higher factor scores per dimension correspond to greater marginalization. Two-sided Chi-squared and t-tests were used to compare demographics between VC and in-person patients with a significance threshold of p < 0.001. Generalized estimating equations logistic regression models were used to assess associations between patient satisfaction and visit type, as well as demographics. Results: YVM was emailed to 28% (10625/37835) of patients with a response rate of 21.8% (2321/10625). Mean and minimum income (x $10,000) were highest among responders (6.6, 1.5) compared to non-responders (6.3, 1.3) and those without email (6.2, 1.1). Comparing responders with VC (n = 549) and in-person (n = 1719) visits, the former had higher mean income (6.9 vs 6.5, p < 0.001) and lower mean EC factor score (0.2 vs 0.4, p < 0.001). Satisfaction with care received was not associated with visit type and satisfaction with VC logistics was not associated with demographics. Patients with higher EC scores were more likely to rate low satisfaction in “culturally appropriate” (OR 0.69, 95% CI: 0.57-0.85) and “respect” (OR 0.69, 95% CI: 0.57-0.85) domains. Patients with higher SV scores were more likely to rate low satisfaction in the “physical symptoms” (OR 0.69, 95% CI: 0.51-0.94) domain, while patients with higher RI scores were more likely to rate low satisfaction in the “physical” (OR 0.82, 95% CI: 0.69-0.98) and “emotional symptoms” (OR 0.88, 95% CI: 0.79-0.98) domains. Conclusions: VC patients had positive experiences with visit logistics across demographics and their satisfaction with care was comparable to that of in-person patients. However, VC use and YVM access, use, and responses were associated with income and socioeconomic status. Identifying populations vulnerable to digital health inequities will guide strategies to bridge the divides.