Study Identifies Oncology Health Professionals’ Conflicting Perceptions of Telehealth

A study published in JAMA Network Open highlighted the conflicting opinions of oncologic health care professionals regarding telehealth and gave insight into potential barriers which need to be further investigated or improved for the expansion and continued utilization of the virtual service.

These results are particularly relevant given the continued effects of the coronavirus disease 2019 (COVID-19) pandemic, which has forced institutions worldwide to design or expand telehealth programs.

“While it remains unclear how long these changes will last, COVID-19 has ushered in a new era for telehealth services, and further research regarding the barriers to offering them due to perceived financial impact is necessary,” wrote the study authors, who were led by Arianna Heyer.

In this qualitative study, investigators used interviews conducted with medical oncology health professionals at the Thomas Jefferson University Hospital from October 30, 2019 to March 5, 2020. Using the National Quality Forum framework, the perceptions of respondents were organized into 4 domains of clinical effectiveness, patient experience, access to care, and financial impact. Notably, all medical oncology physicians, physicians’ assistants, and nurse practitioners at the hospital were allowed to participate.

A combination of volunteer and convenience sampling was used, which resulted in the participation of 29 medical oncology health professionals, consisting of 20 physicians and 9 advanced practice professionals. Of the total study cohort, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years.

Ultimately, it was revealed that respondents disagreed on the clinical effectiveness and possible limitations of physical examinations conducted virtually, as well as the financial impact incurred by patients. The majority did however recognize the convenience and improved access to care for patients provided by telehealth.

Contrastingly though, many respondents also reported concerns about the relationship between health professional and patient over telehealth platforms. Moreover, there were also concerns about the limited ability to comfort patients in a virtual setting.

“Concerns regarding the clinical efficacy of a telehealth physical examination are the most commonly reported challenges for the virtual management of cancer during the COVID-19 pandemic,” noted the authors. “Future research regarding the efficacy of the virtual physical examination, as well as practice recommendations, are necessary given the rapid rise of telehealth for oncologic care.”

Another limitation to the use of telehealth identified in the study was the overall ambiguity of telehealth coverage. In response to the pandemic, a number of private insurers announced they would offer telehealth services at no cost to the patient. Contrastingly, other insurers, such as Pennsylvania Medicaid, indicated that health professionals should bill patients the same for both video and in-person visits.

Further, regarding the delivery of bad news, patient acceptability of telehealth is largely unknown. However, the current study suggested that the majority of health care professionals deem this mode of delivery to be inappropriate.

“Future research is necessary to examine how patients view the acceptability of telehealth in regards to receiving bad news or complex information about their oncologic care,” added the authors.

The current study is not without limitations, including that all but 1 interview was conducted in late 2019. The COVID-19 pandemic may have changed perceptions regarding the use of telehealth, thus this study was limited in its ability to evaluate the current opinions held by health professionals. Importantly though, an ongoing study reevaluating the opinions of oncology health professionals is being conducted at the Thomas Jefferson University Hospital in order to investigate the potential change in perceptions.

Reference:

Heyer A, Granberg RE, Rising KL, Binder AF, Gentsch AT, Handley NR. Medical oncology professionals’ perceptions of telehealth video visits. JAMA Netw Open. 2021;4(1):e2033967. doi: 10.1001/jamanetworkopen.2020.33967