One of the biggest changes we saw in healthcare during the pandemic was the shift to telemedicine. Now that the COVID-19 Public Health Emergency is ending, telemedicine (or telehealth) is one of the key issues Americans have questions about. According to a new study, cancer patients, for example, much prefer online visits over in-person appointments. They’d like to keep that option.
The team’s study analyzed survey responses from 39,268 cancer patients across more than 50,000 visits, comparing telemedicine to in-person visits during and after the height of the COVID-19 pandemic. It was carried out by researchers from Moffitt Cancer Center and published in Journal of the National Comprehensive Cancer Network (JNCCN).
The team found that patients reported consistently better experience of care scores with telemedicine compared with in-person visits over the entire study period. A total of 33,318 patients reported data for in-person visits, and 5,950 reported on telemedicine visits. More patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively).
The study also assessed experience of care over time and found that telemedicine implementation was excellent and is sustainable. Telemedicine was used throughout the cancer care continuum, including screening, diagnosis and follow-up, surveillance, supportive care, procedure preparation and follow-up, and survivorship care.
Careful patient selection is key to success, said Krupal B. Patel, MD, MSc, the study’s lead author. “Certain consults are more appropriate and this will depend on each specialty and sub-specialty. At Moffitt Cancer Center, we have been seeing both new patients to the cancer center and follow up patients virtually. Providers are given independence in making this decision which allows shared decision making between the patient and clinical team.”
Clinicians did express concerns that telemedicine could hamper visit interactions. A face-to-face discussion provides verbal cues that help, for example, determine patient distress. But this study suggests that telemedicine can provide as much of a “connection” as an in person visit.
Patel added that, “If it is apparent that a physical exam is necessary to come up with a treatment plan, then the patient is better served in an in-person setting. The goal is to provide the same level of care via telemedicine as in-person.”
With this shift to telemedicine, there has also been increased interest in home testing. Although Moffit has not started home monitoring programs for routine care, they are looking at other approaches.
Patel cites the following projects at Moffitt: The Anesthesiology Department, led by Nasrin Aldawoodi, is undertaking a pilot study of obtaining home testing in lieu of in-person pre-anesthetic testing appointments for patients who are about to undergo surgery. Another pilot study led by Scott Gilbert has assessed utility of wearable activity monitors and patient reported outcomes for post-cystectomy patients. Finally, a pilot study led by Patel and Brian Gonzalez has assessed the utility of wearable activity monitors and patient reported outcomes in head and cancer patients undergoing chemo/radiation.
“Telemedicine visits can be incorporated in patients’ day-to-day schedule so they can complete their appointments before or after work, or during a break. It gives them flexibility and ultimately increases access,” added senior researcher Philippe E. Spiess, MD, MS, Moffitt Cancer Center, who is also a Member of the National Comprehensive Cancer Network (NCCN) Board of Directors, and Guidelines Steering Committee. “As care providers we should be leading the discussion and advocating on our patients’ behalf for both cross-state licensing and continued reimbursements for telemedicine visits.”
