Cancer Provider and Survivor Experiences With Telehealth During the COVID-19 Pandemic

Abstract

QUESTIONS ASKED: How did the rapid shift to tele-health in response to the COVID-19 pandemic affect delivery of cancer survivorship care from provider and survivor perspectives? SUMMARY ANSWER: Providers largely were more comfortable with using telehealth to deliver cancer survivorship care than cancer survivors were, but reported limited training on using telehealth. More than a quarter of survivor respondents reported benefits of telehealth such as improving access to health care services (25.5%) and saving time traveling to a hospital or clinic (40.1%), but only 19.3% of patients reported that telehealth provided for their health care needs. WHAT WE DID: We surveyed cancer care providers (eg, MD, PA or NP, nurse, navigator, and social worker) through the Commission on Cancer network in October of 2020 to understand experiences with telehealth to deliver cancer survivorship care. Cancer survivors were surveyed through the Commission on Cancer network and patient advocacy organizations. WHAT WE FOUND: There was more agreement between provider and survivor responses that some types of care including discussion of laboratory results or imaging , assessment and/or management of cancer treatment symptoms, nutrition counseling, and patient navigation support could be delivered via telehealth. When we examined responses of appropriate visit types by provider role, we found statistically significant differences by provider role for nearly all visit types, with MDs frequently more likely to identify visits as appropriate for telehealth, and nurses frequently less likely to report visits as appropriate for telehealth. Providers were more concerned about missing something important than survivors were. BIAS, CONFOUNDING FACTOR(S): The survey methodology in our study may not have reached a representative provider or survivor population. The lower comfort levels among survivors may be attributable to less frequent usage of telehealth, which could change over time. We also were unable to conduct in-depth qualitative work to understand reasons for discomfort with telehealth. REAL-LIFE IMPLICATIONS: As revealed in the study, not all forms of patient-practitioner interaction are suitable for telecommunication, but this state of practicing should be evaluated in depth using both qualitative and quantitative approaches to determine proper indications and contraindications of utilization. Future studies of telehealth in cancer care should, thus, explore satisfaction among providers and survivors, and health outcomes for survivors when delivering some care components remotely. abstract PURPOSE The COVID-19 pandemic led to rapid shifts in cancer survivorship care, including the widespread use of telehealth. Given the swift transition and limited data on preferences and experiences around telehealth, we surveyed oncology providers and post-treatment survivors to better understand experiences with the transition to telehealth. METHODS We distributed provider (MD, PA or NP, nurse, navigator, and social worker) and survivor surveys through the American College of Surgeons Commission on Cancer in mid-October 2020. Survivor surveys were also disseminated through patient advocacy organizations. We included questions on demographics, experiences with telehealth, and preferences for future telehealth utilization. RESULTS Among N 5 607 providers and N 5 539 cancer survivors, there was overwhelmingly more support from providers than from survivors for delivery of various types of survivorship care via telehealth and greater comfort with telehealth technologies. The only types of appointments deemed appropriate for survivorship care by both. 50% of providers and survivors were discussion of laboratory results or imaging, assessment and/or management of cancer treatment symptoms, nutrition counseling, and patient navigation support. Only a quarter of survivors reported increased access to health care services (25.5%), and 32.0% reported that they would use telehealth again. CONCLUSION Although there have been drastic changes in technological capabilities and billing reimbursement structures for telehealth, there are still concerns around delivery of a broad range of survivorship care services via telehealth, particularly from the patient perspective. Still, offering telehealth services, where endorsed by providers and if available and acceptable to cancer survivors, may provide more efficient and accessible care following the COVID-19 pandemic.