Telemedicine and gynecologic oncology: caring for patients remotely during a global pandemic

Abstract

<h3>Objectives:</h3> The objective of this project was to investigate care outcomes and patient satisfaction for gynecologic oncology patients participating in telemedicine visits conducted at the authors' institution during the COVID-19 pandemic. <h3>Methods:</h3> Telemedicine visits conducted between 3/23/2020 and 5/14/2020 were reviewed for demographic, clinical, and follow up data. To ascertain patient satisfaction, voluntary patient surveys were conducted by phone after their telemedicine visit using a validated survey used in other telemedicine studies. Physician and advanced practice provider (APP) satisfaction were surveyed at two clinical locations. Proportions compared using chi-square tests. Data analyzed using Stata SE statistical software. <h3>Results:</h3> From 3/23/2020-5/14/2020 there were a total of 281 telemedicine encounters. A total of 42 (15.0%) were new consults, 66 (23.5%) surveillance visits, 104 (37.0%) chemotherapy visits, 27 (9.6%) were postop visits, 30 (10.7%) were problem visits, and 12 (4.3%) were uncategorized visits. A total of 120 visits were for patients with ovarian cancer and 71 visits were for patients with uterine cancer. The remainder of the visits included patients with cervical cancer, vulvar/vaginal cancers, and benign conditions. A total of 11 visits were for patients on a clinical trial and 10/11 (90.9%) were able to continue on trial during this time period. With regards to imaging and labs for patients on trials, there were no protocol deviations. A total of 112 patients who completed telemedicine visits responded to a post visit survey. A total of 109 (97.3%) agreed or strongly agreed that their privacy was respected and 103 (92%) agreed or strongly agreed that their diagnosis and treatment options were adequately explained. A total of 83 (74.1%) of survey participants indicated that they preferred a mixture of telemedicine and in-person visits moving forward, 14 (12.5%) indicated they preferred only in-person visits moving forward and 15 (13.4%) indicated that they preferred only telemedicine visits moving forward. There were no significant differences between telephone and televideo visits with regard to patients agreeing or strongly agreeing that their diagnosis and treatment options were adequately explained (96.8% vs 86%, p=0.12). Similarly, patients agreed or strongly agreed that they could ask questions and seek clarification easily with both telephone and televideo visits (100% vs 94%, p=0.268). Additional patient perceived benefits of telemedicine are displayed in Figure 1. Approximately 80% of physicians and APPs at both clinical locations felt very satisfied or satisfied that clinical goals were achieved. <h3>Conclusions:</h3> Telemedicine has been underutilized in the care of women with gynecologic malignancies until the COVID-19 pandemic. Data from our institution demonstrate successful implementation of a telemedicine program that can be used for all visit types including for patients on clinical trials. Survey data indicate patients and providers view telemedicine favorably.