Hematology/oncology outpatient perspectives on telehealth one year into the COVID-19 pandemic.

Abstract

1594 Background: Telehealth use expanded during the COVID-19 pandemic, but few studies have explored patient perspectives on it after the initial months. Using mixed methods, we aimed to understand patient telehealth perspectives and to examine for whom telehealth is less optimal. Methods: A modified Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) for hematology/oncology outpatient care was sent to patients ≥18 years old within the M Health Fairview Masonic Cancer Clinic with ≥1 prior telehealth visit (phone and/or video). Two focus groups were also conducted. We summarized cohort characteristics and views on telehealth. We dichotomized selected TSUQ items (measured on a 1-5 scale) and evaluated them using logistic regression, adjusted for age (<65 years, ≥65 years), gender, race (White, other), income (<$50,000, $50,000-99,000, ≥$100,000, prefer not to say), education (no college degree, at least college degree), and having cancer (yes, no). Focus group data were analyzed qualitatively. Results: Of 7848 invitations, 588 surveys were completed (7.5% response rate). For respondents, 71% were female, 68.7% married/partnered, 90.6% identified as White, and 36.1% had a graduate/professional degree with an annual salary ≥$150,000 (21%). Most had cancer (73.3%) but were not currently receiving treatment (36.5%); 40% each had employer-based insurance or Medicare. Focus group members (n = 16) were chosen from a demographic mix of 121 volunteers. Most survey respondents found telehealth satisfactory [mean 3.8 ± standard deviation (SD) 0.9] and easy to use (mean 3.4 ± SD 0.9), 72.2% found it convenient, and 82.2% agreed that it saved time. Most (78.6%) would be happy with a combination of telehealth and in-person care going forward, but those with cancer were less likely to prefer future telehealth care (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.34 - 0.81). Being male and having lower incomes were associated with greater telehealth satisfaction, (male vs. female, OR 1.68, 95% CI 1.00 - 2.83), income <$50,000 vs. ≥$100,000 (OR 2.47, 95% CI 1.16 - 5.28). Focus group members reported between 1 - 30 telehealth visits (overall care range 8 months - 30 years). Views on telehealth mirrored survey results. Time saved and reduced exposure risk were beneficial, especially for those in rural settings and for those seeing genetic counselors or palliative care. However, concerns were voiced about fewer in-person interactions, communication gaps, and provider style variability. Conclusions: Our findings show that oncology patients prefer care in person despite telehealth’s benefits. Additional work is needed to ascertain the optimal, and possibly patient subgroup-specific, combination of in-person and telehealth in ambulatory hematology/oncology care to manage the needs of different populations.