Factors Influencing Patient Preferences for Telehealth Cancer Genetic Counseling During the COVID-19 Pandemic

Abstract

PURPOSE: With onset of the COVID-19 pandemic, telehealth became the primary modality for health care appointments. This study examined patient experiences with and preferences for telehealth at a cancer genetic counseling clinic throughout the first 6 months of the pandemic (March-August 2020). METHODS: An anonymous survey assessed patient demographics; usage and prior experience with technology; emotional responses, technical experiences, and satisfaction with the telehealth appointment (via the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire); preference for future telehealth; and recommendation of telehealth to others. RESULTS: Among 380 respondents, most were highly satisfied with the telehealth appointment (with 65.6% and 66.4% of participants completing the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire, respectively). Multivariable analyses indicated several notable findings. Adjusting for relevant covariates, participants with less education felt significantly more concerned about telehealth than those with highest educational attainment. Participants age 40-69 years were generally more comfortable, relieved, and grateful that their appointment was scheduled as telehealth than were those older than 70 years. Women were marginally more relieved and grateful for telehealth appointments than men. As the pandemic progressed, significantly more participants were highly satisfied with their telehealth appointment and participants trended toward having greater preferences for future telehealth use. Most participants (78.6%) would recommend telehealth to others, although 50.8% preferred future in-person appointments. CONCLUSION: As the pandemic progressed, patients expressed increasing preferences for and satisfaction with telehealth. Service delivery models that incorporate individual patient preferences should be developed with special consideration to factors such as age, sex, and education level.

Disparities in cancer genetics care by race/ethnicity among pan‐cancer patients with pathogenic germline variants

“…53 This is an ongoing area of study currently in our clinic, particularly given changing legislation and eligibility around telehealth. 54 Additionally, although language has been identified as a limiting factor, most of our patients identified English as their primary language with some Hispanic and Asian patients identifying a non-English language, mainly Spanish, as their primary language. As efforts are made to reduce disparities in genomics and cancer care, barriers to effectively delivering genetic services to those with limited English proficiency will need to be overcome.…”

Breast Cancer Disparities and the Digital Divide

“…Digital literacy is also central to telehealth’s utility. Patients over 65 and those with low education have less digital literacy and more anxiety about using telehealth [ 30 , 31 ]. The importance of improving digital literacy has been recognized nationally with recent efforts from the Department of Education to reinstate the Community Technology Centers (CTC) program that provides underserved communities with information technology and training to improve use.…”

Leveraging Electronic Health Records to Address Breast Cancer Disparities

“…They could also facilitate patient education on the importance of genetic testing. Furthermore, EHRs could be combined with telegenetic services to increase access to genetic counselors [18,32].…”

“…For example, nearly 1 in 4 households lack broadband internet or internet-compatible devices that support enrolling in EHR portals [ 15 ]. Also, patients with low education or low income, including among racial and ethnic minority groups, may have low digital literacy that limits their ability and willingness to enroll [ 16 – 18 ]. Another factor is language barriers.…”

“…Also, usability could be improved by increasing accessibility to online portals in languages other than English and by offering technical training and assistance programs [ 8 ]. For example, nurse navigators can teach patients how to use telehealth and patient portals [ 8 , 18 , 22 ]. But to be successful, these interventions must coordinate with outreach programs that aim to increase internet and device accessibility.…”