Patient and provider perspectives on telemedicine utilization for Gynecologic Oncologic care among underserved women at an urban teaching hospital in the era of COVID-19 (279)

Abstract

Objectives: The use of telemedicine has dramatically increased during the COVID-19 pandemic, requiring patients and providers to quickly adapt to this new mode of healthcare delivery. Our study objective was to describe patient and provider experiences using telemedicine for gynecologic oncology (GO) care among medically underserved women in an urban academic teaching hospital.Methods: We conducted a prospective study evaluating patient and provider acceptability and feasibility with telemedicine among medically underserved women seeking GO care from January to August 2021. Eligible patients for this sub-analysis included those using telemedicine for GO visits and preoperative or postoperative gynecologic care at a government-funded clinic in New York City. Providers included residents, GO fellows, and nurse practitioners (NPs). A newly developed telemedicine survey and a modified version of the validated Telemedicine Usability Questionnaire (TUQ) were administered to providers and patients, respectively, for each visit. The TUQ has six subscales to assess telemedicine usability, including usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction with mean Likert scale scores calculated for all questions. All statistical analyses were completed using the Wilcoxon signed-rank test. Results: A total of 166 surveys were completed with 28 provider and 27 patient surveys eligible for inclusion in this sub-analysis. 81% (22) visits were completed by video, 19% (5) by phone. Median patient age was 43 (24-67), 52% (14) had at least a college degree, 30% (8) self-identified as Asian, 19% (5) as Black, and 15% (4) as Hispanic. The overall TUQ mean score was 4.26. Subscale mean scores were calculated for usefulness (4.60), ease of use (4.48), interface quality (4.44), interaction quality (4.75), reliability (3.74), and satisfaction/future use (4.59). The reliability mean score, which measures whether patients think telemedicine visits are as good as in-person visits, was significantly lower compared to the other subscales (Table 1). Of the 28 providers, 68% (19) were residents and 32% (9) were GO fellows or NPs. Resident providers’ mean scores for self-perceived ability to adequately counsel patients using telemedicine was significantly lower than that of GO fellows and NPs (p=0.01). Of the 25 paired patient-provider surveys within this cohort, there was high concordance between providers’ self-perceived ability to counsel patients via telemedicine and patients’ satisfaction with the telemedicine services (p=1.00).Conclusions: Women presenting for GO and perioperative visits reported positive experiences using telemedicine. While telemedicine may increase access to healthcare services, patient’s perceptions regarding equivalence to in-person visits is of particular interest in marginalized populations. Teaching hospitals must also evaluate whether providers feel adequately trained to deliver telemedicine visits, with a particular emphasis on trainees.