Virtual Cancer Care During the COVID-19 Pandemic in Alberta: Evidence From a Mixed Methods Evaluation and Key Learnings

Abstract

PURPOSE This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. METHODS Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. RESULTS 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. CONCLUSION The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

“…Many in-person interactions were transitioned to telehealth, which is the provision of health care remotely by means of telecommunications technology (e.g., telephone, video) [ 7 , 8 ]. Increases in telehealth visits were observed across Canada at the start of the pandemic [ 9 , 10 , 11 ].…”

Telehealth cancer care consultations during the COVID-19 pandemic: a qualitative study of the experiences of Australians affected by cancer

“…Other Australian studies have found that patients have less confidence in doctors’ ability to monitor health with telehealth [ 10 , 17 , 19 ]. While some international studies have suggested that the lack of physical contact and limited visual cues in telehealth present challenges to health professionals [ 15 , 36 ], other studies suggest that doctors compensate for this in video consultations by increasing their use of and attention to body language [ 36 ]. Australian patients’ concerns regarding the adequacy of their monitoring through telehealth may reflect the use of the telephone and unfamiliarity with these appointment types.…”

“…Most studies included in the review were from countries other than Australia and most reported on the experience of using video technology for appointments [ 11 ]. Studies published subsequently have continued to demonstrate high levels of satisfaction with telehealth for outpatient appointments in mixed patient populations, with video [ 12 – 14 ] and telephone [ 15 ] formats. However, despite high satisfaction, multiple studies have also shown that most patients prefer in-person consultations [ 16 ] suggesting that a more nuanced understanding of telehealth experiences is needed.…”

Using Autoregressive Integrated Moving Average (ARIMA) Modelling to Forecast Symptom Complexity in an Ambulatory Oncology Clinic: Harnessing Predictive Analytics and Patient-Reported Outcomes

“…It is important to recognize that the error varied week to week, with larger discrepancies between actual and predicted data during the weeks of 26 February 2020 and 4 March 2020. This could be due to the outbreak of COVID-19 in Alberta, which occurred in February 2020 and caused considerable disruptions within cancer care [33,34]. Healthier patients, including those with low symptom complexity, may have been shifted to a virtual appointment and it has been shown that few virtual patients completed the PPF [34].…”

“…This could be due to the outbreak of COVID-19 in Alberta, which occurred in February 2020 and caused considerable disruptions within cancer care [33,34]. Healthier patients, including those with low symptom complexity, may have been shifted to a virtual appointment and it has been shown that few virtual patients completed the PPF [34]. Therefore, these patients would not have been included in the dataset, resulting in fewer low complexity patients being represented.…”