Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma

Abstract

Background and Aims A rapid increase in the use of telemedicine for delivering healthcare has occurred since the onset of the Covid-19 pandemic. There is evidence for using telemedicine to facilitate cancer care delivery for patients with hepatocellular carcinoma (HCC). Examining how telemedicine can be used to communicate multidisciplinary tumor board (MTB) recommendations for HCC has not been studied. This study has two specific aims: (1) to evaluate the patient perspective of the MTB review process and identify best strategies for communicating treatment recommendations for HCC and (2) to pilot test a telemedicine intervention following MTB review to assess patient feasibility and satisfaction with using telemedicine to facilitate treatment decision-making and treatment referral. Methods We conducted a mixed-methods study. First, semi-structured qualitative interviews were conducted among patients diagnosed with HCC who were discussed in MTB review at one of three VA Medical Centers (VAMC). We collected information about the MTB process from the patient perspective and identified strategies for improving communication and delivery of care. Rapid qualitative analysis was used to inform intervention development. Using our qualitative data, a MTB telemedicine pilot intervention was developed and implemented to assess the feasibility of using this approach for patients with HCC. Results Almost all patients (94%) in the pilot study would recommend telemedicine to other patients with HCC, and half of the patients (50%) preferred telemedicine over in-person visits. Many patients (81%) found communication through telemedicine an acceptable platform to deliver difficult cancer information. Overall, patients felt they understood their treatment recommendations and found them clear and useful. Further, patients reported that they enjoyed being included in the decision-making process and appreciated being able to have family members easily join them for the telemedicine visit. Conclusions Using telemedicine to communicate treatment recommendations following MTB review was found to be feasible and an acceptable alternative to an in-person visit for patient with HCC. Future studies could include expanding this approach for communicating MTB recommendations to patients with other types of cancers.

Using Electronic Health Record Mortality Data to Promote Goals-of-Care Discussions in Seriously Ill Transferred Patients: A Pilot Study

“…1) to optimize end-of-life care and avoid higher health care utilization with burdensome care transitions. [32][33][34]…”

COVID-19: Has the Liver Been Spared?

“…In this regard, a rapid increase in the use of telemedicine has occurred since the onset of the COVID-19 pandemic, with the continuous expansion of both access and coverage of its services [ 219 ]. Both European and American guidelines have already recommended the use of telemedicine to replace clinic visits, as well as replacing multidisciplinary team meetings to decrease the risk of the spread of COVID-19 [ 165 , 171 ].…”

“…Both European and American guidelines have already recommended the use of telemedicine to replace clinic visits, as well as replacing multidisciplinary team meetings to decrease the risk of the spread of COVID-19 [ 165 , 171 ]. Moreover, it also allows overcoming barriers to access by reducing or eliminating travel distance, frequency, and associated costs, as testified by patients themselves [ 219 ]. Recent studies, for example, have shown that telemedicine may be an effective way to remotely evaluate HCC patients for liver transplantation [ 220 , 221 ].…”

Predicting Recurrence and Metastasis in Stage III Colorectal Cancer After Laparoscopic Surgery and Laparotomy

“…The American Joint Committee on Cancer (AJCC), TNM system assesses tumor size and invasion (T), lymph node involvement (N), and distant metastasis (M), with stages ranging from 0 (early) to IV (advanced), indicating cancer spread [8]. In stage III colon cancer, the malignancy penetrates the colon wall but does not affect nearby organs or distant locations, commonly involving lymph nodes [9]. Accurate staging guides treatment decisions and provides essential survival estimates, underscoring its pivotal role in managing stage III colon cancer [10].…”