Cancer Provider and Survivor Experiences With Telehealth During the COVID-19 Pandemic

Abstract

PURPOSE The COVID-19 pandemic led to rapid shifts in cancer survivorship care, including the widespread use of telehealth. Given the swift transition and limited data on preferences and experiences around telehealth, we surveyed oncology providers and post-treatment survivors to better understand experiences with the transition to telehealth. METHODS We distributed provider (MD, PA or NP, nurse, navigator, and social worker) and survivor surveys through the American College of Surgeons Commission on Cancer in mid-October 2020. Survivor surveys were also disseminated through patient advocacy organizations. We included questions on demographics, experiences with telehealth, and preferences for future telehealth utilization. RESULTS Among N = 607 providers and N = 539 cancer survivors, there was overwhelmingly more support from providers than from survivors for delivery of various types of survivorship care via telehealth and greater comfort with telehealth technologies. The only types of appointments deemed appropriate for survivorship care by both > 50% of providers and survivors were discussion of laboratory results or imaging, assessment and/or management of cancer treatment symptoms, nutrition counseling, and patient navigation support. Only a quarter of survivors reported increased access to health care services (25.5%), and 32.0% reported that they would use telehealth again. CONCLUSION Although there have been drastic changes in technological capabilities and billing reimbursement structures for telehealth, there are still concerns around delivery of a broad range of survivorship care services via telehealth, particularly from the patient perspective. Still, offering telehealth services, where endorsed by providers and if available and acceptable to cancer survivors, may provide more efficient and accessible care following the COVID-19 pandemic.

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

“…Some studies found that patients’ overall satisfaction with telehealth is high [ 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Reducing exposure to COVID-19 [ 15 , 22 ], including the time- and money-saving benefits of telehealth, promotes telehealth visits as a favorable option during the pandemic [ 10 , 16 , 17 , 20 , 22 , 23 , 24 , 43 , 44 ]. Despite its benefits, some patients felt that telehealth is not a good alternative to in-person visits because it does not optimize patients’ experience (e.g., no physical examinations) (43,44), and may compromise clinician-patient relationship, cybersecurity, and health care accessibility [ 12 , 25 ].…”

“…Globally, telehealth appointments have been well received by patients, with high rates of satisfaction among patients [ 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Benefits of telehealth identified by patients included reduced exposure to COVID-19 [ 15 , 22 ] and convenience (e.g., time and money saved by avoiding travel to in-person appointments) [ 10 , 16 , 17 , 20 , 22 , 23 , 24 ]. However, this rapid shift into telehealth has substantial negative consequences in terms of clinician-patient relationships, cybersecurity and technical aspects, and health care accessibility [ 25 ].…”

“…However, this rapid shift into telehealth has substantial negative consequences in terms of clinician-patient relationships, cybersecurity and technical aspects, and health care accessibility [ 25 ]. Cancer patients have expressed difficulty with cultivating a clinician-patient relationship, and clinicians have had concerns regarding the ability to conduct physical examinations and read physical cues in the patient’s body language [ 12 , 16 , 20 , 23 , 24 , 26 , 27 ]. Moreover, cancer patients preferred in-person appointments for receiving difficult news [ 18 , 20 , 24 ].…”

“…Moreover, cancer patients preferred in-person appointments for receiving difficult news [ 18 , 20 , 24 ]. A small proportion of patients also reported technical issues during telehealth appointments [ 12 , 17 , 22 , 23 ].…”

Experience of a National Cancer Institute-Designated Community Outreach and Engagement Program in Supporting Communities During the COVID-19 Pandemic

“…This, coupled with patient concerns about COVID-19 exposure and inability to advocate for one's health resulted in delays, disruptions, or abandonment of care delivery services in some instances [36]. While cancer centers and healthcare systems have acted to mitigate the repercussions of COVID-19, some practices that we observed, such as the adoption of telemedicine, continue to exacerbate existing disparities and pose additional challenges [37][38][39]. While the long-term consequences of these various disruptions are unknown, we saw that a multifaceted strategy in collaboration with COEs, healthcare systems, community organizations, government institutions, and universities may serve as a solution to addressing disparities amplified by COVID-19 [40].…”