Cancer Treatment During COVID-19: A Qualitative Analysis of Patient-Perceived Risks and Experiences with Virtual Care

Abstract

During the COVID-19 pandemic, most cancer centers shifted from in-person to virtual cancer care to curb community spread and ensure care continuity. This qualitative descriptive study aimed to understand cancer patient-perceived risks related to COVID-19 and cancer treatment, as well as the patient-perceived and experienced value of virtual care. From June to August 2020, focus groups were conducted with patients under active management or observation for a diagnosed malignancy in Toronto, Canada. A thematic analysis of six focus groups found that most participants worried more about treatment delays than they did about COVID-19 infection. Despite some concern about COVID-19 exposure in the hospital, care delays contributed to increased anxiety among participants who already subscribed to strict safety measures in their everyday lives. Most participants accepted virtual care for some appointment types; however, preference for in-person care was found to sustain the humanistic and therapeutic aspects of cancer care that many participants valued. Nuances in the appropriateness and adequacy of virtual cancer care still need exploration. Preserving the humanistic aspects of care is of paramount importance.

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 ].…”

“…Other sociodemographic factors such as race, age, culture, and immigration status have been shown to influence patients’ ability to have successful telehealth appointments, which in turn can worsen patients’ access to health services [ 9 , 25 , 27 , 46 ]. Previous studies have shown that during the pandemic, patients who were older, had shorter treatment duration, identified as a visible minority, were foreign born, were in linguistic isolation, or had recently immigrated had lower preferences for receiving telehealth for their cancer care [ 9 , 13 , 15 , 18 , 24 , 26 ].…”

“…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 ].…”

“…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 ]. A small proportion of patients also reported technical issues during telehealth appointments [ 12 , 17 , 22 , 23 ].…”