When the COVID-19 pandemic came to the United States in the early months of 2020, oncology providers and hospitals everywhere rapidly shifted to telemedicine models to safely continue providing care to patients. Now more than a year later, oncologists say it's important to step back and see how things went.
At the ASCO Annual Meeting, Divya Natesan, MD, Radiation Oncology Chief Resident at Duke University Hospital, and her colleagues presented an analysis of patient satisfaction surveys of thousands of patient visits at Duke University Medical Center (Abstract 1579). The data included all patients who had oncology telehealth via telephone or video (including consults, follow-up appointments, and on-treatment visits) at Duke Cancer Institute from April to November of 2020. All telehealth visits conducted by a physician, physician assistant, or nurse practitioner were included. Patients were administered surveys to rank satisfaction with various aspects of their appointments after each visit unless that patient had an earlier appointment within the previous 3 months. The researchers collected and analyzed data from 2,286 surveys (28% of those administered).
A noteworthy limitation is responder bias, Natesan said. "As with other survey data, it's important to know about the responder biases at play as we interpret the data. In this study, patients who have a particularly positive/negative experience with telehealth may be more motivated to respond to the survey." But overall, the takeaway is that patients were largely satisfied across many domains. "We did see satisfaction improve over time, which reflects the improvements of the technology implementation and learning curve of both providers and patients to this new tool," Natesan told Oncology Times.
1 Why did you and your colleagues conduct this analysis now?
"The COVID-19 pandemic necessitated a shift to telemedicine at the Duke Cancer Institute to minimize the risk of virus exposure. It became apparent during this period that tele-oncology was feasible in many settings and provided additional benefits, such as improving access for those limited by geography or physical limitations, allowing patients to seek second opinions, and providing providers with a tool to augment care/surveillance for high-risk patients.
"Our cancer institute has transitioned back to in-person appointments; however, it is likely that tele-oncology services, in some settings and for certain patient populations, will still remain a tool for us to provide care. We conducted this quality improvement research in order to broadly understand oncology patient satisfaction with telehealth services along the domains of technology, access, care provider interactions, and overall assessment. We also sought to understand if there were differences in satisfaction among different patient populations."
2 What were the most significant findings?
"Overall, we found that satisfaction with telehealth services were high and improved from April 2020 to November 2020 for a number of metrics (including care provider discussion of treatments, care provider inclusion in decisions, likelihood of recommending practice, and overall satisfaction).
"We found that, for most metrics, more than 80 percent of patients were rating telehealth with 5/5 scores. Metrics which remained particularly high (higher than 90%) for telehealth visits were the interactions with the care provider (particularly inclusion in decision-making, care provider explanations, and ease of talking with provider), which was similar to in-person visits. This was reassuring suggesting that respondents did not feel their interactions with their provider about treatment decisions were significantly impacted by the telehealth interface.
"Some of satisfaction differences we found were related to access (ease of scheduling the appointment and contacting the provider via phone/web portal). Millennials and Gen Z generations had a higher rate of satisfaction in this domain (87%) compared to Gen X, Baby Boomers, and the Silent Generation (72-77%). This perhaps reflects differences in ease accessing/using tele-services according to age.
"Another difference we found was that those who indicated 'disabled' as their employment status had higher overall satisfaction (82%) with telehealth services than those who were working full time or retired (71%), suggesting that telehealth services may be improving access for those who are disabled.
"Technology domains were also improved (video/audio connection). We suspect this reflects improvements in the implementation of telehealth services and increased comfort of both providers/patients using this tool. Of note, satisfaction of telehealth compared to in-person [care] also improved (from 52% to 65%); however, [this] still only reflects moderate satisfaction-suggesting many patients may still prefer face-to-face appointments with their oncology physicians."
3 What further research do you think is important when looking at patients' satisfaction with telehealth?
"I think we are still learning about in which settings and for which patients tele-oncology services may be most appropriate. For many patients, face-to-face evaluations are a critical component of diagnosis, treatment, and surveillance, and it may not be appropriate to offer telehealth. I think we learned that this was a feasible tool to implement, but we need to be careful to use it suitably.
"On the other hand, we are learning that tele-oncology services do increase access and mitigate delays in care for a certain patient population. I think we need to work to better define these groups, so we can enhance their cancer care and follow-up.
"Currently, my team and I are piloting the implementation of a telehealth nurse navigator role. As telehealth services are being expanded and implemented as a new care option for patients, providers need additional support as they navigate the changes underpinning this transition. We hope this novel telehealth nurse navigator role will fill this gap by supporting providers and streamlining workflows."