Physician Perspectives on Telemedicine in Radiation Oncology

Abstract

Purpose/Objective(s)Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be utilized after the COVID-19 public health emergency (PHE) ends. Despite ongoing COVID-19 risks and public payer support for telemedicine, several private payers have stopped reimbursing telemedicine weekly see video visits. We performed a large single-institution assessment of provider perspectives on telemedicine after we had achieved a more mature level of adoption to better understand factors considered when determining to use telemedicine and to estimate the percent of visits that could be safely performed with telemedicine.Materials/MethodsWe distributed a survey to all radiation oncology attendings at our large academic institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and to identify factors influencing whether telemedicine is employed. For the qualitative analysis, two authors independently coded open-ended survey responses and identified categories and themes following established content analysis methodology. We calculated the average proportion of visits that providers expected could be appropriately performed with telemedicine without a clinically significant decline in the quality of care for each disease site and visit type.Results60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department, and 83% wished to continue offering video visits after the COVID-19 PHE ends. Common reasons providers endorsed for wanting to integrate telemedicine into practice included: patient and provider preference, increased access to care and clinical trials, allowing for greater relationship with the care team, and improved clinical safety, efficiency, and quality. Patient factors influencing whether physicians offer telemedicine included the patient's travel burden, patient preferences, and whether a physical exam is required. About 20% of new consultations and 50% of weekly management visits were estimated to be clinically appropriate for telemedicine. Central Nervous System/Pediatrics and Thoracic faculty considered telemedicine appropriate for the greatest proportion (50%) of new consultations. 93% of respondents felt comfortable determining whether telemedicine was appropriate.ConclusionSurveyed radiation oncologists were satisfied with telemedicine in their practice and wished to continue offering video visits in the future. Although provider perceptions of clinical appropriateness of telemedicine varied widely based on disease site and visit type, providers felt comfortable determining when telemedicine would be appropriate for patients. Our data suggest payers should continue to support this patient-centered technology.