Abstract
There is increasing interest from cancer patients and their healthcare providers in the use of virtual care in routine clinical practice. In the setting of hematologic malignancy, where patients often undergo complex and immunodepleting treatments, understanding how to use virtual care safely and effectively is critically important. We aimed to describe the use of virtual care in patients with hematologic malignancies and to examine physician- and patient-reported outcomes in the form of a systematic scoping review. An electronic search of PubMed, Ovid MEDLINE, Elsevier Embase, Scopus, and EBSCO CINAHL was conducted from January 2000 to April 2021. A comprehensive search strategy was used to identify relevant articles, and data were extracted to assess the study design, population, setting, patient characteristics, virtual care platform, and study results. Studies were included if they described the use of virtual care for patients with hematologic malignancies; commentaries were excluded. Fifteen studies met the inclusion criteria after abstract and full-text review. Three studies found that app-based tools were effective in monitoring patient symptoms and triggering alerts for more urgent follow-up. Four studies described the use of phone-based interventions. Five studies found that videoconferencing, with both physicians and oncology nurses, was highly rated by patients. Emerging themes included high levels of patient satisfaction across all domains of virtual care. Provider satisfaction scores were rated lower than patient scores, with concerns about technical issues leading to challenges with virtual care. Four studies found that virtual care allowed providers to promptly respond to patient concerns, especially when patients were experiencing side-effects or had questions about their treatment. Overall, the use of virtual care in patients with hematologic malignancies appears feasible, and resulted in high patient satisfaction. Further research is needed in order to evaluate the optimal method of integrating virtual care into clinical practice.
Highlights
The COVID-19 pandemic has motivated clinicians to re-examine the way healthcare is delivered
A 2020 study at a large comprehensive cancer center found that a majority of patients (68%) with virtual care visits were highly satisfied, but over one-third of physicians felt that virtual care early in the COVID-19 pandemic compromised quality [10]; similar findings have been observed in other jurisdictions [9]
Hsiehchen et al found that virtual care for patients with solid tumor malignancies saved an average of 211.4 min of travel time per patient and resulted in no change in rates of chemotherapy discontinuation, emergency department visits, or admissions [14]
Summary
The COVID-19 pandemic has motivated clinicians to re-examine the way healthcare is delivered. The use of virtual care provides a mechanism to overcome challenges associated with travel time and distance to the hospital, which have previously been identified as barriers to access in this population [6]. This transition has motivated a discussion amongst patients and providers as to how virtual care can and should be routinely used in the management of patients with hematologic malignancies. A 2020 study at a large comprehensive cancer center found that a majority of patients (68%) with virtual care visits were highly satisfied, but over one-third of physicians felt that virtual care early in the COVID-19 pandemic compromised quality [10]; similar findings have been observed in other jurisdictions [9].
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