Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

Abstract

Background Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study

“…This like-mindedness bodes well for nurse-patient collaboration on decisions about whether a visit should occur virtually or in person at the cancer center. Similar to our results, recent studies indicate that both patients and clinicians are increasingly receptive to oncology care provision through VCVs and want the option of videoconferencing to extend post-COVID-19 [87,88]. As in previous nursing studies, both patients and nurses in our study acknowledged that video visits could not replace all in-person encounters [24,33,79,83,85,89].…”

“…Ensuring adequate access to VCVs is multifaceted and requires not only that adequate devices and Wi-Fi resources be available and affordable but also that patients and providers have the skills and support to incorporate them into their care services [87,101]. Investigating how digital literacy and access to telehealth technology influence patient and nurse utilization of VCVs, while not addressed in this study, must be a focus of future studies if videoconferencing is to become a mainstay of health care.…”

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

“…In addition, at MCC the Virtual Health Department was established to provide clinical and administrative support to patients prior to the telemedicine appointments and developing patient facing and clinician facing educational materials. 7 …”

“… 5 , 6 While previous studies have focused on smaller patient populations in the prepandemic era, telemedicine was rapidly adopted during the COVID-19 pandemic to improve widespread access to health care. 7 Not only does telemedicine provide substantial cost benefits and improve access, but it can also help in mitigating climate change by providing care from distance. 8 , 9 In this study, we used a large oncology patient data set to estimate the CO 2 emission savings from implementing telemedicine at Moffitt Cancer Center (MCC), a National Cancer Institute (NCI)-designated cancer center.…”

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

“…Third, propensity score methods account for selection bias based on observed factors; however, we still cannot account for unobservable factors that may be associated with potentially preventable ED visits and unplanned hospitalizations. Fourth, given changes in practice patterns (eg, telehealth oncology programs 72 ) and patient care-seeking behavior due to the COVID-19 pandemic, studies are needed to assess the implications of the COVID-19 pandemic for ED visits among patients with cancer.…”