The New Normal? Patient Satisfaction and Usability of Telemedicine in Breast Cancer Care

Abstract

Background. Telemedicine was adopted to minimize exposure risks for patients and staff during the coronavirus disease 2019 pandemic. This study measured patient satisfaction and telemedicine usability in breast cancer care. Methods. Adult breast cancer patients who had a telemedicine visit at a single academic institution (with surgical, radiation, or medical oncology) from 15 June 2020 to 4 September 2020 were surveyed anonymously. Patient and cancer characteristics were collected, and patient satisfaction and telemedicine usability were assessed using a modified Telehealth Usability Questionnaire with a 7-point Likert scale. Associations of satisfaction and usability with patient characteristics were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests. Results. Of 203 patients who agreed to be contacted, 78 responded, yielding a response rate of 38%. The median age of the respondents was 63 years (range 25-83 years). The majority lived in an urban area (61%), were white (92%), and saw a medical oncologist (62%). The median patient satisfaction score was 5.5 (interquartile range [IQR] 4.25-6.25). The median telemedicine usability score was 5.6 (IQR 4.4-6.2). A strong positive correlation was seen between satisfaction and usability, with a Spearman correlation coefficient (q) of 0.80 (p \ 0.001). Satisfaction and usability scores did not vary significantly according to patient age, race, location of residence, insurance status, previous visit commute time, oncology specialty seen, prior telemedicine visits, or whether patients were actively receiving cancer treatment. Conclusions. Breast cancer patients were satisfied with telemedicine and found it usable. Patient satisfaction and telemedicine usability should not limit the use of telemedicine in future post-pandemic breast cancer care.Coronavirus disease-2019 (COVID-19) has prompted health systems to rethink how health care can be delivered in a safe and effective way. To mitigate the risk of COVID-19 transmission between patients, physicians, and nonphysician providers, many health systems have rapidly expanded their use of telemedicine. [1][2][3] Policy changes have further supported this transition in care delivery, namely, relaxation of technology requirements for virtual communication platforms, temporary expansion of recommended telemedicine use cases, and ability of health systems to bill telemedicine services as if they were performed in person. 4,5 Accompanying this temporary expansion in virtual care has been a surge in the literature critically assessing the long-term utility of telemedicine within various care disciplines and patient populations. [6][7][8][9][10][11] The use of telemedicine in oncologic care is of particular interest for two primary reasons. First, patients with cancer often are immunocompromised from their cancer or the treatments they receive, such as chemotherapy or

Telehealth in cancer care during COVID-19: disparities by age, race/ethnicity, and residential status

“…There may be ways to mitigate the disparities we observed. Studies before and during the pandemic, including some of our own work, found that telehealth has been acceptable to many patients [ 31 – 33 ]; for example, through improved care logistics (travel time to visits, time off of work, costs/logistics associated with childcare for time during appointments) and access to specialists that may not be available in some communities (i.e., genetic counselors in rural areas). Our data, however, suggest telehealth is less utilized in some populations.…”

Cancer patients’ satisfaction with telehealth during the COVID-19 pandemic

“…Oncologists have acknowledged both the benefits (e.g., convenience) and drawbacks (e.g., ability to build effective alliances with patients) of delivering care via telemedicine [ 2 , 4 ]. Whereas patients with cancer have generally reported positive aspects of telemedicine, including its convenience and perception that the technology has improved their health in some capacity [ 5 , 6 ].…”

“…Healthcare systems use patient experience (i.e., satisfaction) measures to identify areas of exemplar service and areas of service that require improvement [ 9 ]. Although researchers have demonstrated a positive association between telemedicine usability and patient satisfaction [ 6 ], little is known about the patient-oriented factors that predict patient satisfaction with telehealth in oncology settings during the pandemic. Such factors include the type of technological device used to communicate with oncology clinicians, as well as the purpose of the appointment and general comfort using the technology to interact with their clinician.…”

Breast Medical Oncologists' Perspectives of Telemedicine for Breast Cancer Care: A Survey Study

“…[18][19][20] For example, a survey study of 78 breast cancer patients at the University of Minnesota who had a TM visit in 2020 found high median patient satisfaction scores (5.5 on a scale of 1 to 7) as well as high patient usability scores (median 5.6 on a scale of 1 to 7). 20 In a larger study that took place at 18 centers in France and Italy, 1,299 patients with breast cancer who had undergone TM visits for routine breast cancer follow-up or who were on active therapy during the first wave of the COVID-19 pandemic, reported high rates of patient satisfaction on two separate questionnaires (mean satisfaction scores 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TM satisfaction questionnaires respectively) but expressed concern over lack of breast examination. 18 A prospective randomized control trial of TM versus F2F visits for the routine surveillance of patients with early-stage breast and prostate cancer conducted by the authors of this study is ongoing (ClinicalTrials.gov identifier: NCT04936243) and will measure patients' and clinicians' perspectives on experience and care quality as primary end points.…”