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Bange EM, Daly RM, Lipitz-Snyderman A, Kuperman G, Polubriaginof FCG, Liebertz C, Doshi SD, Stevanovic K, Chan K, Bernal C, Charvadeh YK, Chen Y, Chimonas S, Stetson P, Schrag D, Morris MJ, Panageas KS. Transforming patient-centered cancer care using telehealth: the MATCHES Center. J Natl Cancer Inst Monogr 2024; 2024:76-82. [PMID: 38924792 PMCID: PMC11207685 DOI: 10.1093/jncimonographs/lgae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 06/28/2024] Open
Abstract
Modern cancer care is costly and logistically burdensome for patients and their families despite an expansion of technology and medical advances that create the opportunity for novel approaches to care. Therefore, there is a growing appreciation for the need to leverage these innovations to make cancer care more patient centered and convenient. The Memorial Sloan Kettering Making Telehealth Delivery of Cancer Care at Home Efficient and Safe Telehealth Research Center is a National Cancer Institute-designated and funded Telehealth Research Center of Excellence poised to generate the evidence necessary to inform the appropriate use of telehealth as a strategy to improve access to cancer services that are convenient for patients. The center will evaluate telehealth as a strategy to personalize cancer care delivery to ensure that it is not only safe and effective but also convenient and efficient. In this article, we outline this new center's research strategy, as well as highlight challenges that exist in further integrating telehealth into standard oncology practice based on early experiences.
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Affiliation(s)
- Erin M Bange
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert M Daly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gilad Kuperman
- Department of Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fernanda C G Polubriaginof
- Department of Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chris Liebertz
- Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sahil D Doshi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristina Stevanovic
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kiana Chan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camila Bernal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yasin Khadem Charvadeh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuan Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Stetson
- Department of Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cabrera Chien L, Uranga C, Katheria V. Telemedicine in geriatric oncology - lessons learned from the COVID-19 experience. Curr Opin Support Palliat Care 2024; 18:100-105. [PMID: 38652459 DOI: 10.1097/spc.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Telemedicine quickly became integrated into healthcare caused by the Coronavirus 19 (COVID-19) pandemic. Rapid use of telemedicine into healthcare systems was supported by the World Health Organization and other prominent national organizations to reduce transmission of the virus while continuing to provide access to care. In this review, we explored the effect of this swift change in care and its impact on older adults with cancer. RECENT FINDINGS Older adults are susceptible to the COVID-19 virus caused by various risk factors, such as comorbidity, frailty, decreased immunity, and cancer increases vulnerability to infection, hospitalization, and mortality. We found three major themes emerged in the literature published in the past 18 months, including access to care, telemedicine modes of communication, and the use of technology by older adults with cancer. These findings have brought insight into issues regarding healthcare disparities. SUMMARY The utilization of telemedicine by older adults with cancer has potential future benefits with the integration of technology preparation prior to the patient's initial visit and addressing known health disparities. The hybrid model of care provides in-person and or remote access to clinicians which may allow older adults with cancer the flexibility needed to obtain quality cancer care.
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Odebunmi OO, Hughes TD, Waters AR, Urick BY, Herron C, Wangen M, Rohweder C, Ferrari RM, Marciniak MW, Wheeler SB, Brenner AT, Shah PD. Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey. J Med Internet Res 2024; 26:e50205. [PMID: 38780994 PMCID: PMC11157176 DOI: 10.2196/50205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 02/16/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this. OBJECTIVE This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. METHODS We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. RESULTS Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. CONCLUSIONS Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable.
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Affiliation(s)
- Olufeyisayo O Odebunmi
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Tamera D Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Austin R Waters
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Benjamin Y Urick
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
- Prime Therapeutics, Eagan, MN, United States
| | - Caroline Herron
- Syracuse Veterans Affairs Medical Center, Syracuse, NY, United States
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Department of Maternal and Child Health, University of North Carolina, Chapel Hill, NC, United States
| | - Macary W Marciniak
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Toni E, Ayatollahi H. An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review. BMC Med Inform Decis Mak 2024; 24:104. [PMID: 38641567 PMCID: PMC11027268 DOI: 10.1186/s12911-024-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/12/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic. METHODS This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively. RESULTS A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates. CONCLUSION The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.
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Affiliation(s)
- Esmaeel Toni
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Bange EM, Li Y, Kumar P, Doucette A, Gabriel P, Parikh R, Li EH, Mamtani R, Getz KD. The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer. Cancer 2024; 130:636-644. [PMID: 37987207 PMCID: PMC10922036 DOI: 10.1002/cncr.35116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/31/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality. METHODS This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits. RESULTS The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38). CONCLUSIONS In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.
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Affiliation(s)
- Erin M Bange
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pallavi Kumar
- Palliative and Hospice Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail Doucette
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Gabriel
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Hematology/Oncology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Eric H Li
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly D Getz
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Praha N, Sriyuktasuth A, Puwarawuttipanit W, Chuengsaman P, Kusakunniran W. Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study. J Med Internet Res 2023; 25:e48623. [PMID: 38051557 PMCID: PMC10731559 DOI: 10.2196/48623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. OBJECTIVE This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. METHODS This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. RESULTS A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03). CONCLUSIONS This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.
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Affiliation(s)
- Nattaya Praha
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | | | | | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
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KURNIAWAN ARIF, GAMELIA ELVIERA, ANANDARI DIAN. The theory behind and factors influencing the use of telemedicine during the COVID-19 pandemic: A systematic review. J Public Health Afr 2023; 14:2592. [PMID: 38162328 PMCID: PMC10755515 DOI: 10.4081/jphia.2023.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/09/2023] [Indexed: 01/03/2024] Open
Abstract
A paradigm change in patient health care toward telemedicine services was necessary in 2020 due to the COVID-19 pandemic, which broke out at the end of 2019. Theories used in determining the determinants of telemedicine utilization are various theories. Research conducted on the use of telemedicine still has doubts about the basic theory used in analyzing the factors that influence telemedicine, especially during the Covid-19 pandemic. The goal of this study is to outline the fundamental principles of telemedicine utilization during the Covid-19 outbreak and the variables that affect it. This Literature Review uses the scoping review method with the tool procedure, namely PRISMA. Based on the conducted literature review, there are 12 scholarly papers addressing the variables that affect the utilization of telemedicine services. During the Covid 19 epidemic, more individuals in many nations used telemedicine services. Anderson's theory of health care use and the idea of technology adoption or acceptance serve as the foundational theories for forecasting the variables that affect the use of telemedicine. The utilization of telemedicine is influenced by 29 different factors that come from different theories. The desire for health, exposure to COVID 19, co-morbidities, social media usage, avoiding contamination, time efficiency, ease of use of services, social impact, and hedonic incentive are among the factors associated to the COVID 19 pandemic.
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Affiliation(s)
- ARIF KURNIAWAN
- Public Health Department, Faculty of Health Sciences, University of Jenderal Soedirman, Indonesia
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Mackwood M, Butcher R, Vaclavik D, Alford-Teaster JA, Curtis KM, Lowry M, Tosteson TD, Zhao W, Tosteson ANA. Adoption of Telemedicine in a Rural US Cancer Center Amid the COVID-19 Pandemic: Qualitative Study. JMIR Cancer 2022; 8:e33768. [PMID: 35895904 PMCID: PMC9384858 DOI: 10.2196/33768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated a rapid shift to telemedicine to minimize patient and provider exposure risks. While telemedicine has been used in a variety of primary and specialty care settings for many years, it has been slow to be adopted in oncology care. Health care provider and administrator perspectives on factors affecting telemedicine use in oncology settings are not well understood, and the conditions associated with the COVID-19 pandemic offered the opportunity to study the adoption of telemedicine and the resulting provider and staff perspectives on its use. OBJECTIVE The aim of this paper is to study the factors that influenced telemedicine uptake and sustained use in outpatient oncology clinics at a US cancer center to inform future telemedicine practices. METHODS We used purposive sampling to recruit a mix of oncology specialty providers, practice managers, as well as nursing and administrative staff representing 5 outpatient oncology clinics affiliated with the Dartmouth Cancer Center, a large regional cancer center in the northeast of United States, to participate in semistructured interviews conducted over 6 weeks in spring 2021. The interview guide was informed by the 5 domains of the Consolidated Framework for Implementation Research, which include inner and outer setting factors, characteristics of the intervention (ie, telemedicine modality), individual-level factors (eg, provider and patient characteristics), and implementation processes. In total, 11 providers, 3 leaders, and 6 staff participated following verbal consent, and thematic saturation was reached across the full sample. We used a mixed deductive and inductive qualitative analysis approach to study the main influences on telemedicine uptake, implementation, and sustainability during the first year of the COVID-19 pandemic across the 5 settings. RESULTS The predominant influencers of telemedicine adoption in this study were individual provider experiences and assumptions about patient preference and accessibility. Providers' early telemedicine experiences, especially if negative, influenced preferences for telephone over video and affected sustained use. Telemedicine was most favorably viewed for lower-acuity cancer care, visits less dependent on physical exam, and for patient and caregiver education. A lack of clinical champions, leadership guidance, and vision hindered the implementation of standardized practices and were cited as essential for telemedicine sustainability. Respondents expressed anxiety about sustaining telemedicine use if reimbursements for telephonic visits diminished or ceased. Opportunities to enhance future efforts include a need to provide additional guidance supporting telemedicine use cases and evidence of effectiveness in oncology care and to address provider concerns with communication quality. CONCLUSIONS In a setting of decentralized care processes, early challenges in telemedicine implementation had an outsized impact on the nature and amount of sustained use. Proactively designed telemedicine care processes with attention to patient needs will be essential to support a sustained role for telemedicine in cancer care.
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Affiliation(s)
- Matthew Mackwood
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Rebecca Butcher
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Danielle Vaclavik
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Kevin M Curtis
- Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Mary Lowry
- Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Tor D Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Wenyan Zhao
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Anna N A Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United States
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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