Telemedicine Adoption in an NCI-Designated Cancer Center During the COVID-19 Pandemic: A Report on Patient Experience of Care

Authors:
Krupal B. Patel Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida

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 MD, MSc
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Amir Alishahi Tabriz Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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 MD, PhD, MPH
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Kea Turner Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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 PhD, MPH
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Brian D. Gonzalez Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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Laura B. Oswald Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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Heather S.L. Jim Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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Oliver T. Nguyen Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida

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Young-Rock Hong Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida

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Nasrin Aldawoodi Department of Anesthesia, Moffitt Cancer Center, Tampa, Florida

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Biwei Cao Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida

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Xuefeng Wang Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida

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Dana E. Rollison Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida

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Edmondo J. Robinson Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
Center for Digital Health, Moffitt Cancer Center, Tampa, Florida

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Cristina Naso Virtual Health Program, Moffitt Cancer Center, Tampa, Florida

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Philippe E. Spiess Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida

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Volume/Issue:
Volume 21: Issue 5
Online Publication Date:
May 2023
DOI:
https://doi.org/10.6004/jnccn.2023.7008
Restricted access

Background: Patients with cancer require timely access to care so that healthcare providers can prepare an optimal treatment plan with significant implications for quality of life and mortality. The COVID-19 pandemic spurred rapid adoption of telemedicine in oncology, but study of patient experience of care with telemedicine in this population has been limited. We assessed overall patient experience of care with telemedicine at an NCI-designated Comprehensive Cancer Center during the COVID-19 pandemic and examined changes in patient experience over time. Patients and Methods: This was a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center. Press Ganey surveys were used to assess patient experience. Data from patients with appointments between April 1, 2020, and June 30, 2021, were analyzed. Patient experience was compared between telemedicine and in-person visits, and patient experience with telemedicine over time was described. Results: A total of 33,318 patients reported Press Ganey data for in-person visits, and 5,950 reported Press Ganey data for telemedicine visits. Relative to patients with in-person visits, more patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively) (P<.001). When adjusted for age, race/ethnicity, sex, insurance, and clinic type, telemedicine visits consistently outperformed in-person visits over time regarding access and care provider concern (P<.001). There were no significant changes over time in satisfaction with telemedicine visits regarding access, care provider concern, telemedicine technology, or overall assessment (P>.05). Conclusions: In this study, a large oncology dataset showed that telemedicine resulted in better patient experience of care in terms of access and care provider concern compared with in-person visits. Patient experience of care with telemedicine visits did not change over time, suggesting that implementing telemedicine was effective.

Submitted July 10, 2022; final revision received November 30, 2022; accepted for publication February 2, 2023.

Previous presentation: Part of this manuscript was presented at the ATA2022 Annual Conference & Expo; May 1–3, 2022; Boston, Massachusetts.

Author contributions: Conceptualization: Patel, Alishai Tabriz, Turner, Gonzalez, Naso, Spiess. Data curation: Patel, Naso. Formal analysis: Patel, Cao, Wang. Methodology: Patel, Rollison, Naso, Spiess. Writing: Patel, Alishai Tabriz, Turner, Gonzalez, Oswald, Jim, Nguyen, Hong, Aldawoodi, Rollison, Robinson, Naso, Spiess.

Disclosures: Dr. Gonzalez has disclosed serving on an advisory board for Eli Lilly; and as a consultant for Sure Med Compliance, Elly Health, and KemPharm. Dr. Jim has disclosed serving as a consultant for Janssen Scientific Affairs and Merck & Co., Inc.; as a principal investigator for Kite Pharma; and as a consultant for SBR Life Sciences. Dr. Rollison has disclosed holding an executive position, serving on a governance board, or being employed by NanoString Technologies, Inc. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported in part by the Biostatistics & Bioinformatics Shared Resource at the H. Lee Moffitt Cancer Center & Research Institute and funded in part by Moffitt’s Cancer Center Support Grant (P30-CA076292).

Correspondence: Krupal B. Patel, MD, MSc, Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612. Email: krupal.patel@moffitt.org

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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
  • 1.

    Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21:335–337.

  • 2.

    Al-Shamsi HO, Alhazzani W, Alhuraiji A, et al. A practical approach to the management of cancer patients during the novel coronavirus disease 2019 (COVID-19) pandemic: an international collaborative group. Oncologist 2020;25:e936–945.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Kircher S, Braccio N, Gallagher K, et al. Meeting patients where they are: policy platform for telehealth and cancer care delivery. J Natl Compr Canc Netw 2021;19:1470–1474.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Weigel G, Ramaswamy A, Sobel L, et al. Opportunities and barriers for telemedicine in the U.S. during the COVID-19 emergency and beyond. Accessed April 1, 2022. Available at: https://www.kff.org/womens-health-policy/issue-brief/opportunities-and-barriers-for-telemedicine-in-the-u-s-during-the-covid-19-emergency-and-beyond/

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19. JAMA Oncol 2020;6:1698–1699.

  • 6.

    Kircher SM, Mulcahy M, Kalyan A, et al. Telemedicine in oncology and reimbursement policy during COVID-19 and beyond. J Natl Compr Canc Netw 2020;19:1–7.

  • 7.

    Mehrotra A, Bhatia RS, Snoswell CL. Paying for telemedicine after the pandemic. JAMA 2021;325:431–432.

  • 8.

    Ramaswamy A, Yu M, Drangsholt S, et al. Patient satisfaction with telemedicine during the COVID-19 pandemic: retrospective cohort study. J Med Internet Res 2020;22:e20786.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Johnson BA, Lindgren BR, Blaes AH, et al. The new normal? Patient satisfaction and usability of telemedicine in breast cancer care. Ann Surg Oncol 2021;28:5668–5676.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Martinez KA, Rood M, Jhangiani N, et al. Patterns of use and correlates of patient satisfaction with a large nationwide direct to consumer telemedicine service. J Gen Intern Med 2018;33:1768–1773.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Tenforde AS, Borgstrom H, Polich G, et al. Outpatient physical, occupational, and speech therapy synchronous telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. Am J Phys Med Rehabil 2020;99:977–981.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Turner K, Bobonis Babilonia M, Naso C, et al. Health care providers’ and professionals’ experiences with telehealth oncology implementation during the COVID-19 pandemic: a qualitative study. J Med Internet Res 2022;24:e29635.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Richard JV, Wilcock AD, Schwamm LH, et al. Assessment of telestroke capacity in US hospitals. JAMA Neurol 2020;77:1035–1037.

  • 14.

    Zhang D, Wang G, Zhu W, et al. Expansion of telestroke services improves quality of care provided in super rural areas. Health Aff (Millwood) 2018;37:2005–2013.

  • 15.

    Pareek P, Vishnoi JR, Kombathula SH, et al. Teleoncology: the youngest pillar of oncology. JCO Glob Oncol 2020;6:1455–1460.

  • 16.

    Shaverdian N, Gillespie EF, Cha E, et al. Impact of telemedicine on patient satisfaction and perceptions of care quality in radiation oncology. J Natl Compr Canc Netw 2021;19:1174–1180.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Powell RE, Henstenburg JM, Cooper G, et al. Patient perceptions of telehealth primary care video visits. Ann Fam Med 2017;15:225–229.

  • 18.

    Predmore ZS, Roth E, Breslau J, et al. Assessment of patient preferences for telehealth in post-COVID-19 pandemic health care. JAMA Netw Open 2021;4:e2136405.

  • 19.

    Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol 2020;31:894–901.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol 2020;21:1023–1034.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Dress J. Moffitt Cancer Center’s virtual visits up 5,000% in response to COVID-19. Accessed April 1, 2022. Available at: https://www.beckershospitalreview.com/oncology/moffitt-cancer-center-s-virtual-visits-up-5-000-in-response-to-covid-19.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Prasad A, Brewster R, Newman JG, et al. Optimizing your telemedicine visit during the COVID-19 pandemic: practice guidelines for patients with head and neck cancer. Head Neck 2020;42:1317–1321.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Kang JJ, Wong RJ, Sherman EJ, et al. The 3 Bs of cancer care amid the COVID-19 pandemic crisis: “be safe, be smart, be kind” – a multidisciplinary approach increasing the use of radiation and embracing telemedicine for head and neck cancer. Cancer 2020;126:4092–4104.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Chang PJ, Jay GM, Kalpakjian C, et al. Patient and provider-reported satisfaction of cancer rehabilitation telemedicine visits during the COVID-19 pandemic. PM R 2021;13:1362–1368.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Darcourt JG, Aparicio K, Dorsey PM, et al. Analysis of the implementation of telehealth visits for care of patients with cancer in Houston during the COVID-19 pandemic. JCO Oncol Pract 2021;17:e36–43.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Elkaddoum R, Haddad FG, Eid R, et al. Telemedicine for cancer patients during COVID-19 pandemic: between threats and opportunities. Future Oncol 2020;16:1225–1227.

  • 27.

    Jiang CY, El-Kouri NT, Elliot D, et al. Telehealth for cancer care in veterans: opportunities and challenges revealed by COVID. JCO Oncol Pract 2021;17:22–29.

  • 28.

    Holland JC, Andersen B, Breitbart WS, et al. Distress management. J Natl Compr Canc Netw 2013;11:190–209.

  • 29.

    Mast MS. On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns 2007;67:315–318.

  • 30.

    Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ 2000;320:1517–1520.

  • 31.

    Kratzke IM, Rosenbaum ME, Cox C, et al. Effect of clear vs standard covered masks on communication with patients during surgical clinic encounters: a randomized clinical trial. JAMA Surg 2021;156:372–378.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Sabesan S, Allen D, Caldwell P, et al. Practical aspects of telehealth: doctor-patient relationship and communication. Intern Med J 2014;44:101–103.

  • 33.

    Schmidt KL, Gentry A, Monin JK, et al. Demonstration of facial communication of emotion through telehospice videophone contact. Telemed J E Health 2011;17:399–401.

  • 34.

    Sabesan S, Simcox K, Marr I. Medical oncology clinics through videoconferencing: an acceptable telehealth model for rural patients and health workers. Intern Med J 2012;42:780–785.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Mooi JK, Whop LJ, Valery PC, et al. Teleoncology for indigenous patients: the responses of patients and health workers. Aust J Rural Health 2012;20:265–269.

  • 36.

    Doolittle GC, Spaulding AO. Providing access to oncology care for rural patients via telemedicine. J Oncol Pract 2006;2:228–230.

  • 37.

    Houts PS, Lipton A, Harvey HA, et al. Nonmedical costs to patients and their families associated with outpatient chemotherapy. Cancer 1984;53:2388–2392.

  • 38.

    Kangovi S, Barg FK, Carter T, et al. Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff (Millwood) 2013;32:1196–1203.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Salloum RG, Smith TJ, Jensen GA, et al. Factors associated with adherence to chemotherapy guidelines in patients with non-small cell lung cancer. Lung Cancer 2012;75:255–260.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Ambroggi M, Biasini C, Del Giovane C, et al. Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist 2015;20:1378–1385.

  • 41.

    Jiang C, Yabroff KR, Deng L, et al. Self-reported transportation barriers to health care among US cancer survivors. JAMA Oncol 2022;8:775–778.

  • 42.

    Diaz A, Schoenbrunner A, Pawlik TM. Trends in the geospatial distribution of inpatient adult surgical services across the United States. Ann Surg 2021;273:121–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Bynum AB, Irwin CA, Cranford CO, et al. The impact of telemedicine on patients’ cost savings: some preliminary findings. Telemed J E Health 2003;9:361–367.

  • 44.

    Rodriguez JA, Clark CR, Bates DW. Digital health equity as a necessity in the 21st century Cures Act era. JAMA 2020;323:2381–2382.

  • 45.

    Lau J, Knudsen J, Jackson H, et al. Staying connected in the COVID-19 pandemic: telehealth at the largest safety-net system in the United States. Health Aff (Millwood) 2020;39:1437–1442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Nouri S, Khoong E, Lyles CR, et al. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic. Accessed April 1, 2022. Available at: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0123

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Knudsen KE, Willman C, Winn R. Optimizing the use of telemedicine in oncology care: postpandemic opportunities. Clin Cancer Res 2021;27:933–936.

  • 48.

    Eyrich NW, Andino JJ, Fessell DP. Bridging the digital divide to avoid leaving the most vulnerable behind. JAMA Surg 2021;156:703–704.

  • 49.

    Schmidt AL, Bakouny Z, Bhalla S, et al. Cancer care disparities during the COVID-19 pandemic: COVID-19 and Cancer Outcomes Study. Cancer Cell 2020;38:769–770.

  • 50.

    Elston Lafata J, Smith AB, Wood WA, et al. Virtual visits in oncology: enhancing care quality while designing for equity. JCO Oncol Pract 2021;17:220–223.

  • 51.

    Roberts ET, Mehrotra A. Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine. JAMA Intern Med 2020;180:1386–1389.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Pew Research Center. Mobile fact sheet. Accessed April 1, 2022. Available at: https://www.pewresearch.org/internet/fact-sheet/mobile/

  • 53.

    DeGuzman PB, Bernacchi V, Cupp CA, et al. Beyond broadband: digital inclusion as a driver of inequities in access to rural cancer care. J Cancer Surviv 2020;14:643–652.

    • PubMed
    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2023 by the National Comprehensive Cancer Network 2023
Article Category:
Research Article
Received:
10 Jul 2022
Accepted:
02 Feb 2023
Print Publication Date:
01 May 2023
Online Publication Date:
May 2023
Keywords:
Telemedicine; Telehealth; Tele-oncology; Patient Satisfaction; Press Ganey

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