Patients with Cancer Report Satisfaction with Telemedicine both Before and During Pandemic

Telemedicine in radiation oncology practice inspires both confidence and satisfaction in patients, according to study findings published in the Journal of the National Comprehensive Cancer Network.

Findings from this study suggest that the optimization of telemedicine should be a priority in oncology settings, with a focus on accessible audiovisual capabilities to improve communication between the patient and their oncologist.

Among the patients who had participated in telemedicine, 45% preferred it to in-office visits, 34% preferred in-office visits, and 21% had no preference.

Overall, 1,077 patients completed a satisfaction survey, of which 726 had participated in office visits and 351 had participated in telemedicine. The rate of satisfaction between the office group and telemedicine group was fairly similar regarding appointment experience versus expectation, quality of physician’s explanation, and level of physician concern and friendliness.

Patients with superior performance status (odds ratio [OR], 1.04; 95% CI, 1.00–1.08; P = .047) and who were either married or partnered (OR, 2.41; 95% CI, 1.14–5.47; P = .009) had a high tendency to prefer in-person visits. Patients who participated in telephone-only telemedicine encounters (without any audiovisual component) were more likely prefer an office visit to better understand their treatment plan (OR, 2.25; 95% CI, 1.00–4.77; P = .04).

In comparing telemedicine with an in-office visit, 90% found physician confidence to be better or the same, 88% found treatment plan comprehension to be better or the same, and 87% found that their treatment confidence was better or the same.

“Patient satisfaction in oncology is a multifactorial outcome that considers a range of factors, including interpersonal interactions, appointment length and efficiency, provider thoroughness, and perceptions of care coordination,” Narek Shaverdian, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), and colleagues wrote in the study. “Therefore, the high patient satisfaction with telemedicine despite the COVID-19 pandemic, wherein patients are facing increased vulnerability and myriad new stressors, further supports the use of telemedicine in oncology practice.”

The study assessed patients who visited MSKCC, at either its main campus or any of the 6 regional centers across New York and New Jersey, between December 2019 through June 2020. These patients were asked to complete patient experience questionnaires designed to assess satisfaction levels between office and telemedicine consultations, patient visit-type preferences, and which factors were associated with office visits.

The study included 2 cohorts of patients: pre-pandemic and intra-pandemic participants. The pre-pandemic range was defined as December 1, 2019, through February 28, 2020. The intra-pandemic period included patients seen between April 2, 2020 and June 10, 2020. In mid-March 2020, telemedicine rapidly became the default means of consultation visits. These telemedicine appointments included both telephone-only options as well as interactive audiovisual capabilities via smartphone or tablets/laptops/etc. There were no defined polices regarding an audiovisual versus telephone encounter, nor were there specific restrictions regarding the physical location of the telemedicine encounters throughout the meeting. Any appointment-type decisions were decided on a by-meeting basis by patients and providers.

Across most visit types, the majority of survey respondents selected the top score when grading their appointment experience versus expectations of telemedicine vs in-office visits (82% vs 84%, respectively), the quality of their physician’s explanations (91% vs 84%), and the level of concern (92% vs 93%) and friendliness (95% vs 94%) shown by their physician.

A total of 93% of patients who participated in telemedicine and a total of 92% of those who participated in in-person visits stated that they were very likely to recommend their physician to others.

Researchers adjusted findings for age, sex, race/ethnicity, radiation consultation intent, cancer diagnosis, presence of symptomatic or metastatic disease, and length of visit, but found that only a higher performance status and having a life partner were associated with a preference for in-person visits. Similarly, none of those factors were associated with a preference for in-person office visit for treatment understanding.

In regard to the ongoing COVID-19 pandemic, 34% of patients answered that they believed “cancer care [would] be negatively impacted.” However, only 8% of patient respondents believed that their own disease would not be “successfully treated.”

Some patients were concerned that their treatment success would be negatively impacted by the pandemic. Seven percent of those who preferred telemedicine expressed this concern, compared with 5% of those who preferred on-site visits (P = .64). The survey did not determine which factors would cause patients to express said concern. Despite this, data did reveal that patients with prostate (OR, 0.21; 95% CI, 0.06–0.66; P=.009) or breast cancer (OR, 0.22; 95% CI, 0.06–075; P=.02) were significantly less likely to be concerned that the pandemic would impact their treatment compared with other cancer types.

According to the study authors, one notable takeaway from the study was that 66% of patients reported reduced treatment-related costs with telemedicine. Similarly, patients who were not married or partnered had a higher preference for telemedicine, perhaps because the burden of travel was reduced. As the study authors noted, travel burden has been labeled as an obstacle to best care in complex cancer surgery as it is linked to reduced chemotherapy and radiation receipt.

The reduction in costs and in travel burden illustrate telemedicine’s potentially advantageous position for patients today and beyond the pandemic era–so long as the required technology is made accessible to all patients. However, as nearly one-quarter of Medicare beneficiaries do not currently have either a smart phone or a computer with high-speed internet connection, the advantages of telemedicine are still not accessible to the most vulnerable patients.

“Although the study did not detect evidence that COVID-19 affected the preference for a telemedicine encounter, post pandemic studies assessing telemedicine patient satisfaction will be required to confirm this study findings,” authors concluded. “Similarly, future studies may seek to focus on diverse patient populations and qualitative data less prone to the ceiling effect.”

References:

Shaverdian N, Gillespie EF, Cha E, et al. Impact of telemedicine on patient satisfaction and perceptions of care quality in radiation oncology. J Natl Compr Canc Netw. 2021;19(10):1174-1180. doi:10.6004/jnccn.2020.7687