Accessibility and Impact of Telehealth in Rural Populations with a History of Cancer

Abstract

After the COVID-19 pandemic, telehealth (TH) has been increasingly utilized in healthcare delivery. We aim to analyze the preference and availability of TH for participants with a history of cancer (HC) and hypothesize HC in rural areas will have lower access to TH compared to metropolitan residents (metro). From June-November 2020, individuals who had participated in past OSU studies, cancer patients, their nominated caregivers and those on OSU community partner listservs were asked to participate in a survey to understand the pandemic's impacts on healthcare access. A follow-up survey was distributed from March-July 2021. Survey data were merged with information from the OSU James Cancer Registry to confirm history of cancer. Only participants with HC were included in this analysis. Participants were asked demographic questions and questions to assess preferences and accessibility regarding TH. Chi-square tests as well as Wilcoxon Rank Sum Test were used to review the bivariate associations between demographic and TH variables with rural/metro residence. Of 9,280 who completed the first survey, 7,224 (77.8%) also completed the second survey, and 3,536 were HC (891 rural, 2,645 metro). The median age was 63 years, 63.3% of the participants were women, 89.0% were non-Hispanic white, 15.0% had public health insurance, 53.3% had a college degree or higher, 46.8% of the patients had an income >$75K. In metro areas, more participants were black, had an education of at least a college degree and had higher incomes compared to those in rural areas (p<0.001 for all). Otherwise, there were no differences in patient characteristics between rural and metro HC. When asked TH specific variables, patients in rural areas were less likely to have a smart phone (48.8% vs. 54%), less likely to have internet access (57.8% vs. 62.23%), more likely to be concerned about the cost of internet at home (18% vs. 14.8%), less likely to have participated in video TH visit since the pandemic (27.1% vs. 36.1%) (p<.01 for all). There was no difference in participation in TH by phone, satisfaction with the TH visit, or perception that TH made seeing a provider easier (p>0.05 for all) between rural and metro participants. Participants in rural areas were less likely to have internet access, which may have a role in their decreased engagement with video TH since the pandemic, compared to metro participants. However, there was no difference in use of telephone visits. Video visits are known to allow a more comprehensive evaluation including visual assessments. Although TH options are desirable for those residing further from medical centers, barriers to completion of successful virtual visits have limited more widespread adoption of TH among this patient population. Future efforts to improve care for rural populations should focus on improving disparities in access to quality telecommunication services and expanded connections with rural providers to provide comprehensive care.