Perspectives of older women with early breast cancer on telemedicine during post-primary treatment

Abstract

Purpose Telemedicine has the potential to lessen healthcare burden of older patients due to frequent appointments, physical disabilities, and reliance on caretakers. To benefit from telemedicine, patients must have the capacity and willingness to engage with technology. This study aimed to better understand the telemedicine experiences of older women with nonmetastatic breast cancer regarding visit convenience, completeness, and interpersonal satisfaction. Methods Semi-structured interviews were conducted in a convenience sample of women age 65+, post-primary treatment for stage I-III breast cancer, who had received in-person outpatient care at a cancer center in urban North Carolina before a telemedicine appointment occurring after March 2020. Patients were interviewed about their perceptions of telemedicine (telephone, video) as compared to in-person visits. Audio files of interviews were transcribed and analyzed for themes and subthemes established a priori in the interview protocol. Results Fifteen patients (telephone = 5, video = 10) were consented and interviewed July-October 2021, mean age 74. Thirteen participants reported they preferred a hybrid care model that included telemedicine care over in-person care alone. COVID-19, physical disability, and transportation burden were the most common factors for telemedicine preference. Comfort with familiar face-to-face interactions and having a physical exam were common factors for in-person appointment preference. In-person appointment was favored early in the post-primary treatment phase; telemedicine was more acceptable when relationships were well-established and patients were farther out from diagnosis. Conclusions Patient-provider discussions about appointment modality should take into account newness of diagnosis, patient familiarity with the care team, travel burden, and necessity of physical exam.

Telemedicine in geriatric oncology – lessons learned from the COVID-19 experience

“…An evident trend that emerged from the literature included the crucial benefits from a face-to-face visit. Older adults preferred telemedicine for basic health concerns; however, face to face visits were preferred for physical exams and more serious/complex issues including hearing bad news [27 ▪ ,28]. Telemedicine is a form of communication that can be instrumental in symptom management for patients with cancer including managing pain, nausea, and vomiting [4].…”

“…A group of primary care physicians and geriatricians found that proper training of older adults and clinicians was vital to the success of telemedicine [32]. Responses of older adults with breast cancer interviews included a need for training before their initial appointment would be beneficial to improve telemedicine [28]. Practice recommendations from CARG for telemedicine included education and coordination of technology platforms for older adults with cancer and caregivers [12].…”

“…This includes patients with cognitive impairments and disabilities, such as vision and hearing loss [5,10]. Providers can include techniques during video visits to accommodate patients with hearing and vision difficulties: speak slowly, enunciate words, stop speaking between sentences and speak in a louder voice [28,32]. Communication barriers related to cognitive impairment, vision, hearing impairment, and digital literacy can be addressed by engaging family and caregivers to assist during telemedicine visits [20].…”

Telehealth in breast cancer following the coronavirus disease 2019 pandemic

“…The acceptability of telemedicine among BC patients is also depended on the phase relative to primary treatment. Indeed, in the primary treatment phase and directly after, patients preferred full physical exam to telemedicine due to fear of recurrence [ 50 ]. Although most of responders in their study were satisfied with E-TFU, Merz et al [ 33 ] report that only 43.8% of BC survivors would like to have E-TFU after the pandemic.…”

“…Indeed, with the ageing of the population, telemedicine should also adapt itself to older women with hearing and vision loss. The use of large computer screens instead of smartphones for a better perception of body language, as well as the help of patients support system for oral communication, are potential solutions for adults with sensory difficulties [ 50 ]. Racial inequalities were also reported, where Asian and non-Hispanic white women were more likely to use telemedicine than Black and Hispanic women [ 53 ].…”