Breaking Bad News via Telemedicine: A New Challenge at Times of an Epidemic

Wolf, Ido; Waissengrin, Barliz; Pelles, Sharon

doi:10.1634/theoncologist.2020-0284

Cited by 48 publications

(52 citation statements)

References 5 publications

(3 reference statements)

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“…The majority of patients indicated preferences for a combination of telemedicine and face-to-face appointments, and it is interesting that more than half of patients did not decline hearing negative results on the phone. This finding in particular is against many of the dogmatic principles of “breaking bad news” 13 and is a key observation for understanding patients appropriate for telemedicine-based care.…”

Section: Discussionmentioning

confidence: 81%

Telemedicine During the COVID-19 Pandemic: Impact on Care for Rare Cancers

Smrke

Younger

Wilson³

et al. 2020

JCO Global Oncology

104

129

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PURPOSE Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic. METHODS Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences. RESULTS Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time. CONCLUSION Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.

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Section: Discussionmentioning

confidence: 81%

Telemedicine During the COVID-19 Pandemic: Impact on Care for Rare Cancers

Smrke

Younger

Wilson³

et al. 2020

JCO Global Oncology

104

129

View full text Add to dashboard Cite

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“…It should be acknowledged that telemedicine services have some limitations: (1) the absence of physical interactions (eg, eye contact, handshake), which may play a comforting role for patients; (2) interferences, lapses, delays, or interruptions due to service connection problems; and (3) difficulties associated with communicating bad news [ 21 ]. In a time of crisis, such as the COVID-19 pandemic, these difficulties can be overcome but must be taken into considerations if the use of telemedicine is to be integrated into routine clinical care.…”

Section: Discussionmentioning

confidence: 99%

Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study

Guarino¹,

Cossiga²,

Fiorentino³

et al. 2020

J Med Internet Res

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Background The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. Objective The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. Methods From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. Results During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. Conclusions Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

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“…The COVID-19 pandemic has given a boost to the emerging concept of the virtual or decentralized trial, which is a siteless study in which patient recruitment is done via Web-based methods that involve social media, patient portal and telemedicine applications, informed consent via remote electronic document access, review and signature, some trial activities done via video conference, physical examination done via remote visit or in-home nurse visit, laboratory specimen collection done by local clinics or in-home phlebotomist visit or patient service draw centers, data collection via digital health devices or ePROs, shipping of drugs to the patient’s home, and outcomes collected by remote methods using digital tools. 49 A fully virtual trial is not feasible for most cancer studies, given the need for detailed and often delicate discussions, especially at the time of informed consent 50 ; intravenous drug administrations; medical imaging; and toxicity surveillance. However, decentralizing some elements when appropriate could make conventional trials more efficient, potentially reducing patient burden and consequential clinical trial dropout and optimizing health care resource utilization.…”

Section: Increased Use Of Technologymentioning

confidence: 99%