Cancer Docs Say Telehealth Improves Access to Care, Hedge on Cost

Medical oncology professionals had differing opinions on the clinical effectiveness, financial impact, and patient experience of virtual care, while most agreed that telehealth provided patients with better access to care, according to a new study published in JAMA Network Open.

In this qualitative interview study of 29 medical oncology health professionals at Thomas Jefferson University Hospital, researchers categorized respondents’ telehealth perceptions into the four domains of National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact.

It is important to note that this study was conducted prior to COVID-19, so perceptions may have changed due to a spike in telehealth use.

Respondents had differing views on the clinical effectiveness of telehealth for oncologic care. In particular, health professionals’ opinions differed on the merit of virtual physical examinations.

Some medical oncology professionals said they could examine a sore throat, graft vs. host disease, or shortness of breath via telehealth, while others said they could not assess those characteristics. For that reason, some health professionals said that telehealth is inappropriate for first appointments, patients who are seen every six months to one year, and multiple successive appointments.

On the other hand, some respondents supported the use of telehealth in oncological care, noting that it would allow for more patient interactions. Additionally, telehealth could be utilized for high-risk patients to anticipate potential hospital admissions or emergency department visits.

Many professionals noted that patient-provider relationships are especially important in oncology and expressed a decreased ability to support and bond with a patient through telehealth. Respondents also noted it could be difficult for patients to understand treatment discussions virtually.

Several respondents also noted discussions regarding serious or bad news were not feasible via telehealth. However, other respondents found telehealth to improve patient experience, saying it allows for more frequent follow-up and enhanced access to care.

One oncology professional noted that patients living far from large, comprehensive cancer centers, can remain under the care of experts who specialize in their type of cancer virtually while receiving treatment locally. Additionally, patients can see their oncologist without interrupting responsibilities at home such as caregiving.

Health professionals had differing opinions on the utility of telehealth for acute issues as well. One respondent felt that telehealth was beneficial, as it allowed for patient concerns to be addressed in real time and increased availability of in-person appointments for critically ill patients. Conversely, another respondent felt that addressing acute issues via telehealth could lead to delays in necessary interventions like hospital admission.

Respondents agreed that the technology required for telehealth visits were restrictive for older patients, patients who do not speak English, and patients with limited socioeconomic resources.

Oncology health professionals had opposing views on the financial impact of telehealth care. Some respondents reported that certain patients found copayments for virtual visits unacceptable because they did not consider the visit “real” or equal to in-person appointments. Others felt as though the costs eliminated by telehealth such as parking, gas, tolls, and lost work time made virtual care cost-beneficial for patients.

“It is important to note that all but one interview was conducted between October 30 and November 22, 2019. Therefore, this study is limited in its ability to assess current perceptions of medical oncology health professionals, whose views of telehealth may have changed after a surge in use during the COVID-19 pandemic,” the authors wrote.

With the adoption of an oncology telehealth task force, Thomas Jefferson University Hospital cancer center saw an increase in telehealth appointments, from one percent of all visits in February 2020 to 52.4 percent in April 2020.

“In order to investigate the changing perceptions of telehealth during the COVID-19 pandemic, we have an ongoing study reevaluating oncology health professionals’ insights at our institution,” the authors noted.