Telemedicine garners higher rankings than in-person visits among patients with cancer
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Key takeaways:
- More patients who had telemedicine vs. in-person visits reported high satisfaction with access and care provider concern.
- Satisfaction with telemedicine visits did not significantly change over time.
Telemedicine garnered higher satisfaction ratings than in-person visits among patients with cancer in terms of access and care provider concern, according to a study published in Journal of the National Comprehensive Cancer Network.
Analysis of telemedicine data from the COVID-19 pandemic showed no variation in patient experience of care rates over time, indicating that telemedicine is effective and has potential as a continued aspect of cancer care delivery, researchers wrote.
“The pandemic forced a reshuffling of precious health care resources. Providers looking after [patients with cancer] needed innovative approaches for high-quality and timely care,” Krupal B. Patel, MD, MSc, assistant member in the department of head and neck-endocrine oncology at Moffitt Cancer Center, said in a press release. “Anecdotally, we knew from the feedback of clinical providers that our telemedicine implementation was effective and efficient. However, it was important to have surrogate outcome measures from the patients’ perspective. Patient experience surveys provided us with an opportunity to study this in more detail.”
Background and methodology
Telemedicine became much more heavily utilized throughout the COVID-19 pandemic in the oncology field, but studies of patients’ experience of care with telemedicine during this period remain limited.
Researchers conducted a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center through appointments between April 1, 2020, and June 30, 2021, in an effort to examine patient experience over time. They used Press Ganey Outpatient Medical Practice Survey and Telemedicine Survey data to compare patient experience of care with telemedicine (n = 5,950) vs. in-person visits (n = 33,318), as well as patient experience with telemedicine over time.
Results, next steps
When compared with patients who had in-person visits, more patients with telemedicine visits expressed higher satisfaction with access (62.5% vs. 75.8%) and care provider concern (84.2% vs. 90.7%).
Telemedicine visits continued to outperform in-person visits over time with regard access and care provider concern when adjusted for age, race/ethnicity, sex, insurance and clinic type (P < .001).
Researchers noted no significant changes over time in satisfaction with telemedicine visits in terms of access, care provider concern, telemedicine technology or overall assessment (P > .05).
The study points to telemedicine as an important facet of cancer care moving forward, according to researchers.
“Telemedicine visits can be incorporated in patients’ day-to-day schedules so they can complete their appointments before or after work, or during a break. It gives them flexibility and ultimately increases access,” Philippe E. Spiess, MD, MS, member of the NCCN board of directors and guidelines steering committee and vice chair of the NCCN guidelines panel for bladder/penile cancers, said in the release. “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.”
References:
- Patel KB, et al. J Natl Compr Canc Netw. 2023;doi:10.6004/jnccn.2023.7008.
- New research in JNCCN finds telemedicine consistently outperforms in-person visits for cancer care when both are available (press release). Available at: https://www.nccn.org/home/news/newsdetails?NewsId=3826. Published May 8, 2023. Accessed May 8, 2023.
Perspective
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Claudio Brunstein, MD, PhD
Patel and colleagues reported on the telemedicine experience of patients with cancer treated at their institution during the COVID-19 pandemic. They analyzed the data from the Press Ganey Outpatient Medical Practice Survey and Telemedicine Survey, focusing on access to care and provider concern scores. The survey was sent to patients who had in-person visits (n = 163,850 of 540,184 patients) and telemedicine visits (n = 22,988 of 50,945 patients), and response rates were 20% and 25%, respectively. Their main findings were that telemedicine patients scored higher for these two questions, both overall and over time, compared with in-person visits.Although many institutions had been developing models to deliver care through telemedicine, the COVID-19 pandemic drove the health care industry to rapidly embrace and expand telemedicine care. During the pandemic, the unequivocal benefits of telemedicine were to preserve access to health care while limiting the risk for patient and health care provider exposure to COVID-19 in cases where in-person visits were necessary.
Telemedicine visits are convenient as they can be done from home, scheduling is more flexible, reduces time in transit/traffic, and the patient can have other family members present at the visit. These advantages of telemedicine are particularly important for patients who live farther away from the clinic or hospital where they receive cancer care.
In contrast, telemedicine visits limit the ability of the health care provider to perform a physical exam and observe unspoken cues and body language, especially important in visits to discuss a new cancer diagnosis or progression and treatment options.
Now, in a post-pandemic world, patients with cancer remain interested in telemedicine visits. However, it is less so about safety, and more about convenience of a visit from home or in the middle of the day from one’s business office, thereby saving time, minimizing loss productivity, and reducing out-of-the pocket costs in gas and parking.
Health care providers and systems continue to work on defining and refining the criteria for telemedicine-based visits that tailor to the patient’s clinical condition and complexity of cancer care. There are, however, barriers to telemedicine regarding technology literacy and access for patients who are elderly, poor, belong to an underrepresented minority or live in rural areas. These barriers need to be addressed by initiatives like the newest Cleveland Clinic hospital in Mentor, Ohio, which was equipped with technology to allow remote consultation in the inpatient and outpatients settings.
Now that the COVID-19 pandemic has subsided and the state of emergency has been declared officially over, we will need to adapt telemedicine and navigate challenges such as medical licensure and insurance coverage across state lines. Although the report by Patel and colleagues showed better scores during the COVID-19 pandemic, the absolute difference between telemedicine and in-person was small and the take-home message may be that telemedicine was not inferior to in-person care when it comes to patient experience and provider concern scores. Overall, the creativity and progress made in deployment, workflows, insurance coverage, and technology and technical support makes it clear that telemedicine is here to stay.
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