TELEPORT STUDY: A Pilot Feasibility Trial Examining The Use of Telehealth in Post Radiation Therapy Visits
Phase: NA
Conditions: Malignant Neoplasm
Sponsor: Sidney Kimmel Comprehensive Cancer Center at Thomas Jefferson University

 
 
 
 
Version 6.0 (2017-10-16) 
THOMAS JEFFERSON UNIVERSITY 
Kimmel Cancer Center 
 
TELEPORT STUDY:  
A Pilot Feasibility Trial Examining The Use of Telehealth in 
Post Radiation Therapy Visits  
 
Principal Investigator: 
Nicole Simone, MD* 
Radiation Oncology 
Bodine Cancer Center, G-301G 
215-955-6702 
Co-Investigator(s): 
 
 
 
 
 
 
  
 
 
 
 
 
Non-consenting  
Co-Investigator(s): 
 
 
Protocol Number: 
15D.580 
*Investigator allowed to perform Telehealth visits for New Jersey residents 
 
Version: Date: 
Initial 
8/27/15 
v2.0 
2/8/16 
V3.0 
03/03/16 
V4.0 
06/03/16 
V5.0.1 
06/08/17 
V.6.0 
10/16/17 
 
CONFIDENTIAL 
 
This document is confidential and the property of THOMAS JEFFERSON 
UNIVERSITY.  No part of it may be transmitted, reproduced, published, or 
used by other persons without prior written authorization from the study 
sponsor. 

 
 
 
 
 
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Table of Contents 
STUDY SUMMARY 
 
1 
INTRODUCTION 
7 
1.1 
SPECIFIC AIMS AND HYPOTHESIS 
7 
1.2 
BACKGROUND & RATIONALE 
8 
1.3 
STUDY THERAPY 
9 
1.4 
CLINICAL DATA TO DATE 
10 
1.5 
DOSE RATIONALE AND RISK/BENEFITS 
12 
2 
STUDY OBJECTIVES 
12 
2.1 
PRIMARY OBJECTIVE 
12 
2.2 
SECONDARY OBJECTIVE(S) 
12 
3 
STUDY DESIGN 
12 
3.1 
GENERAL DESIGN 
12 
3.2 
PRIMARY STUDY ENDPOINTS 
13 
3.3 
SECONDARY STUDY ENDPOINTS 
13 
4 
SUBJECT SELECTION AND WITHDRAWAL 
14 
4.1 
INCLUSION CRITERIA 
14 
4.2 
EXCLUSION CRITERIA 
14 
4.3 
GENDER/MINORITY/PEDIATRIC INCLUSION FOR RESEARCH 
14 
4.4 
SUBJECT RECRUITMENT AND SCREENING 
14 
4.5 
EARLY WITHDRAWAL OF SUBJECTS 
14 
4.5.1 
When and How to Withdraw Subjects 
14 
4.5.2 
Data Collection and Follow-up for Withdrawn Subjects 
15 
5 
STUDY DRUG/THERAPY 
15 
5.1 
DESCRIPTION 
15 
5.2 
TREATMENT REGIMEN 
16 
5.3 
RISKS 
16 
5.4 
METHOD FOR ASSIGNING SUBJECTS TO TREATMENT GROUPS 
16 
5.5 
PREPARATION AND ADMINISTRATION OF STUDY DRUG/THERAPY 
16 
5.6 
SUBJECT COMPLIANCE MONITORING 
16 
6 
STUDY PROCEDURES 
16 
6.1 
STUDY VISIT SCHEDULE                                                                                                                                          
16 
 
6.1.1 STUDY FLOW CHART 
17 
7 
STATISTICAL PLAN 
17 
7.1 
SAMPLE SIZE DETERMINATION 
17 
7.2 
STATISTICAL METHODS 
18 
7.3 
SUBJECT POPULATION(S) FOR ANALYSIS 
18 
8 
DATA HANDLING AND RECORD KEEPING 
18 
8.1 
CONFIDENTIALITY 
18 

 
 
 
 
 
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8.2 
SOURCE DOCUMENTS 
19 
8.3 
CASE REPORT FORMS 
19 
8.4 
RECORDS RETENTION 
19 
9 
STUDY MONITORING, AUDITING, AND INSPECTING 
19 
9.1 
STUDY MONITORING PLAN 
19 
9.2 
AUDITING AND INSPECTING 
20 
9.2.1 
Independent External and Internal Audits 
20 
10 
ETHICAL CONSIDERATIONS 
21 
11 
STUDY FINANCES 
21 
11.1 
FUNDING SOURCE 
21 
11.2 
CONFLICT OF INTEREST 
21 
12 
PUBLICATION PLAN 
21 
13 
REFERENCES 
22 
14 
APPENDICES 
25 
 
 
 
 
 
 

 
 
 
 
 
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List of Abbreviations 
TELEPORT- Telehealth in post radiation therapy visits 
RT – radiation therapy 
KPS - Karnofsky Performance Status 
PSCC – patient satisfaction with cancer care scale 
CAT – communication assessment tool  
 
 
 
 
 
 
 
 

 
 
 
 
 
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Study Summary 
Title 
TELEPORT Study: A Pilot Feasibility Trial Examining The 
Use of Telehealth in Post Radiation Therapy Visits 
Short Title 
TELEPORT Study: Telehealth in Radiation Oncology 
Protocol Number 
15D.580 
Phase 
single arm pilot study 
Methodology/Study 
Design 
Any malignancy or benign condition treated with radiation 
single arm feasibility study 
Study Duration 
 24 months for enrollment; 32 months for study duration 
Study Center(s) 
Single-center  
Objectives 
Primary objective: 
- 
to investigate the feasibility of conducting a future 
phase 2 randomized study comparing telehealth and 
in person visits for patients returning for a post-
radiation treatment visit 
 
Secondary objectives: 
- 
 To examine patient satisfaction with a telehealth 
visit  
- 
To examine patient assessment of physician 
communication during a telehealth  
- 
To examine patient distrust in the healthcare system 
following a telehealth visit  
- 
To examine physician ability to perform a patient 
assessment during a telehealth visit  
- 
To examine physician perceptions of telehealth visits  
- 
To examine monetary and time cost to patients for 
telehealth visits 
- 
To calculate clinic savings derived from telehealth 
visits 
Number of 
Subjects 
65 
Diagnosis and 
Main Inclusion 
Criteria 
Patients receiving RT for any indication 
Study Therapy, 
Telehealth visit for the first post treatment follow up 

 
 
 
 
 
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Dose, Route, 
Regimen 
Duration of 
administration and 
follow-up 
Follow up visit 3-8 weeks after completion of radiation 
treatment 
Reference therapy 
Standard in person office visit for first post treatment follow 
up 
Statistical 
Methodology 
 
Schema 
Subject Signs Consent 
 
 
Eligibility is checked; demographics obtained 
 
Subject registered to Jeff Trial Data base 
 
At completion of radiation treatment, subject is provided with a date and 
time for post-treatment follow up  
 
        
Subject has post-treatment 
follow up as a telehealth visit 
 
Both treating physician and patient are emailed links to respective surveys 
immediately following visit                                     
 
Subject is emailed an online                         
  reminder weekly after completion of follow-up visit and has until 4 weeks 
from the date of the visit to complete  
 
 

 
 
 
 
 
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1.0 INTRODUCTION 
This document is a protocol for a human research study. This study is to be 
conducted according to US and international standards of Good Clinical Practice 
(FDA Title 21 part 312 and International Conference on Harmonization 
guidelines), applicable government regulations and Institutional research policies 
and procedures.  
 
1.1 Specific Aims and Hypothesis 
The aim of the study is to determine the feasibility of conducting a future 
randomized trial comparing virtual teleheath visits and in person office visits for 
post treatment radiation follow up visits. Due to the length of cancer treatment, 
many oncology patients have had a long interruption of their normal daily lives, 
including leave of absences from work and additional, non-treatment office visits, 
contribute to further disruption of  patients’ lives when they are just beginning to 
resume their normal activities. After radiation therapy is complete however, 
patients may have side effects that warrant evaluation and therefore a post-
radiation office visit has become standard for all patients who have received 
radiation. Minimizing the direct impact of this visit on patients’ lives may have a 
positive impact on their post-treatment quality of life. One method to do so may 
involve a virtual office visit, which can be performed in the comfort of a patient’s 
home or even in the workplace. This would decrease their time traveling to the 
doctor’s appointment and waiting time in the waiting room as well as potentially 
decreasing cost to the patient. At this time however, it is unknown if a virtual visit 
would be sufficient for both the patient and the doctor, in terms of satisfaction and 
effectiveness of the visit.  
 
In this proposal, we intend to investigate the feasibility of conducting a future 
randomized clinical trial comparing a telehealth and an in person office post 
radiation treatment visit. In addition we intend to examine patient and physician 
attitudes towards telehealth visits as well as physician effectiveness and will 
assess temporal and monetary costs of the visit for the patients. 
 
We hypothesize we will be able to enroll enough patients in this study to justify a 
future randomized clinical trial comparing virtual post-radiation evaluations and in 
person visits. We hypothesize virtual visits will be satisfactory in terms of patient 
satisfaction, perception of physician communication and healthcare distrust. We 
further hypothesize that monetary cost, and time expenditure for patients will be 
decreased for telehealth visits as compared to theoretically calculated costs of in 
person office visits. 
 

 
 
 
 
 
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Aim 1: To determine the feasibility of conducting a future randomized trial 
comparing telehealth and in person visits. 
 
Aim 2: To determine the patient and physician satisfaction as well as clinical 
effectiveness of telehealth visit in radiation oncology clinics as determined by 
patient and physician assessment 
 
Aim 3: to determine whether the monetary and time costs associated with 
telehealth visits are decreased compared to an in person visit  
 
1.2 Background and Rationale 
Telemedicine refers to the use of telecommunications technology to deliver 
health care services to individuals at some distance from the provider (Currell, 
2000). Driven by rapid advancements in technology, interest has steadily grown 
in the use of telemedicine, which has the potential to lower health care costs and 
improve patient access to care (Currell, 2000; Mair and Whitten, 2000).  
 
Routine follow up care after primary cancer treatment is a promising application 
of telemedicine. Objectives of follow-up include management of complications 
from treatment, detection of recurrence, and provision of psychological support 
and information to the patient (Ataman, 2004; van Hezewijk, 2011). With 
increasing demand on outpatient services and limited resources, effectiveness of 
traditional follow-up care at accomplishing these objectives has come under 
scrutiny (James, 1994; Brada, 1995; Teagle, 2014).  
 
In a variety of different cancers, including breast, colorectal, and testicular, 
physical examination has not been shown to significantly contribute to the 
detection of recurrence (Jeffery, 2007; Montgomery, 2007; Cunniffe, 2012). 
Furthermore, a number of studies have shown that telephone follow-up can be as 
effective as face-to-face visits at addressing the psycho-social effects of disease 
and treatment (Gotay, 1998; Beaver, 2010; Marcus, 2010). Nurses who 
conducted telephone follow-up for early stage breast cancer patients expressed 
confidence in their ability to deliver care through telemedicine platforms (Beaver, 
2010).  
 
Feasibility and acceptability of remote follow-up after treatment has been shown 
in high grade glioma, breast, prostate, bladder, endometrial, and colorectal 
cancers (Sardell, 2000; Faithfull, 2001; Shaida, 2007; Beaver, 2009; Kimman, 
2010; Smits, 2015). In a randomized trial, Beaver et al. found that breast cancer 
patients who received follow up through the telephone were no more anxious 

 
 
 
 
 
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despite foregoing physical examination. Patients reported higher levels of 
satisfaction with telephone follow-up compared to traditional outpatient services 
with no impairment in the detection of recurrence. Patients cite convenience, 
reduced travel and wait times, and lower cost as reasons for their preference for 
remote follow-up (Mair and Whitten, 2000; Beaver, 2010). In another study, 
Shaida et al. examined patient satisfaction with nurse-led telephone follow-up of 
patients with prostate cancer. They found no significant differences in general 
satisfaction or perception of professional care between telephone and outpatient 
consultations. However patients who received telephone consultations were less 
satisfied in terms of depth of relationship with provider and perceived time of visit, 
perhaps suggesting some limitations in the use of technology to connect with 
patients.  
 
While evidence is promising, the majority of studies examining telemedicine in 
follow-up care are not randomized, have small patient numbers and do not use 
validated tools to assess patient satisfaction. Also, no studies have examined the 
role of telemedicine in a radiation oncology setting (Dickinson, 2014). Our study 
aims to confirm patient and physician satisfaction with remote follow-up care 
using validated tools. We aim to show the acceptability of telemedicine follow-up 
for patients who have undergone radiotherapy, particularly focusing on the first 
visit following completion of treatment. 
 
1.3 Study Therapy 
Telemedicine refers to the use of telecommunications technology to deliver 
health care services to individuals at some distance from the provider. It has 
become an increasingly popular option across various medical specialties, with 
several studies demonstrating its potential clinical effectiveness. Earlier this year, 
Thomas Jefferson University Hospital launched an institution-wide TH program to 
use Telehealth to better connect with patients and their families. Applications 
have included, but are not limited to, virtual rounds, remote consults, and 
emergent visits. Training programs for providers, including a program for a 
Telehealth Coordinator, are being developed by the NACT education working 
group.  
 
Through the new Telehealth service provided by TJUH, patients are able to 
connect with TJUH doctors through a smartphone, tablet or computer to receive 
real-time care, such as on demand visits, scheduled online visits and remote 
second opinions, from any location convenient to them.  
 

 
 
 
 
 
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In this trial, patients will receive their first post radiation treatment follow up as a 
virtual visit using Telehealth. During the visit, the patients will use the application 
from their own home or any other off-campus location that is convenient for them. 
 
 
1.4 Clinical Data to Date 
Several studies have examined patient perceptions of remote health care 
delivery. In a 2009 multicenter study from the UK, women  with breast cancer with 
low to moderate risk of recurrence were randomized to telephone or hospital 
follow up after completion of treatment. Patients randomized to the telephone 
follow up receive phone calls from breast care nurses at regular intervals as per 
hospital policy. Patients in the hospital follow up group went for in person hospital 
follow up visits as per hospital policy. The study measured patient psychological 
morbidity, information needs, patients’ satisfaction and time to recurrence. 
Participants’ satisfaction with information received and with dealing with patient 
concerns was improved in the telephone group as compared to the hospital group 
(table 1 and 2). Patient anxiety was comparable in the two groups (figure 1).  
 

 
 
 
 
 
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Table 1: Satisfaction with information received by randomized group. Numbers 
are percent of women 

 
 
 
 
 
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Table 2: helpfulness in dealing with concerns at appointment by randomized 
group. Numbers are percent of women 
 
 
Figure 1: mean differences with 95% confidence intervals for telephone group 
minus hospital group for state-trait anxiety inventory 
 

 
 
 
 
 
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In a 2015 prospective study from the UK, approximately 250 patients with 
dermatological conditions seen in a general practice setting who would have been 
subsequently referred to a dermatologist had a teledermatology visit instead. 
Over the course of 2 years this strategy resulted in an estimated saving of 
$18,600. 97% of patients rated themselves as satisfied or very satisfied with the 
process and 93% felt comfortable with the process.  
 
1.5 Dose Rationale and Risk/Benefits 
If during the telehealth visit the treating physician feels he or she is unable to fully 
assess the patient, or has any concerns, he or she will ask the patient to come in 
for an in person visit.  
 
2.0 STUDY OBJECTIVES 
2.1 Primary Objective: 
The primary objective is to examine feasibility of conducting a trial comparing a 
telehealth visit and an in person office visit 
 
2.2 Secondary Objective: 
The secondary objectives of this study include to examine patient satisfaction, 
patient assessment of physician communication during a telehealth visit; to 
examine patient distrust in the healthcare system following a telehealth visit; to 
examine physician ability to perform a patient assessment during a telehealth 
visit; to examine physician perceptions of telehealth visits; to examine monetary 
and time cost to patients for telehealth visit; to calculate clinic savings derived 
from telehealth visits. 
 
3.0 STUDY DESIGN 
3.1 General Design 
This is a single arm pilot feasibility study examining a telehealth visit for the first 
post radiation treatment visit. Patients will be asked to fill out a questionnaire 
within a week of the visit. There will be no subsequent follow up per trial.  
The expected enrollment duration of the study is 24 months. The overall study 
duration is expected to be 32 months.  

 
 
 
 
 
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3.2 Primary Study Endpoints 
The primary endpoint of the study is feasibility (i.e., rate of accrual) of conducting 
a future randomized clinical trial comparing telehealth and in person visits 
 

 
 
 
 
 
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3.3 Secondary Study Endpoints 
Secondary endpoints include: 
- 
patient satisfaction with telehealth visits as measured by the PSCC (see 
appendix II). In the PSCC each item is scored on a 1-5 scale, 
corresponding to statements ranging from strongly agree to strongly 
disagree.   
- 
patient assessment of physician communication during a post-treatment 
visit as measured by the CAT (see appendix II). In the CAT each item is 
scored on a 1-5 rating scale, with higher scores indicating higher 
satisfaction with physician communication.  
- 
patient distrust in the healthcare system as measured by the health care 
system distrust scale (see appendix II). Items are scored strongly disagree 
to strongly agree.  
- 
physician ability to evaluate a patient during a telehealth visit as measured 
by the physician questionnaire (see appendix II). Individual items are 
scored yes, no or N/A 
- 
physician satisfaction with post-treatment telehealth visit as measured by 
the modified physician satisfaction scale (see appendix II). Individual items 
are scored strongly disagree to strongly agree.   
- 
patient and clinic costs for a telehealth visit  
 
4.0 SUBJECT SELECTION AND WITHDRAWAL 
4.1 Inclusion Criteria 
1. Patients who underwent, currently undergoing or planned to start radiation 
treatment with curative, adjuvant or palliative intent, who have not yet had 
their first post-treatment visit 
2. Age ≥ 18 
3. KPS score ≥ 60  
4. Patients must be capable to read and speak English and provide study 
specific informed consent prior to study entry 
5. Patients must have access to a computer or smartphone, email and 
internet connection at home or at a location convenient to them on which 
they would be willing to do a telehealth study 
6. Pennsylvania or New Jersey residents* 
 
*Telehealth visits for New Jersey residents will only be performed by physicians 
with a current medical license issued by the state of New Jersey. 
 
4.2 Exclusion Criteria 
1. Patients under the age of 18 

 
 
 
 
 
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2. KPS <60%  
3. No access to a computer, smartphone or internet 
4. Unable to read and/or speak English 
5. Decisionally impaired patients 
6. Patients not residing in Pennsylvania or New Jersey 
 
4.3 Gender/Minority/Pediatric Inclusion for Research 
This protocol will enroll women and men with any malignancy or benign condition 
treated with radiation therapy and will include minorities in the research protocol. 
Pediatric patients will be excluded. 
 
4.4 Subject Recruitment and Screening 
Patients who are 18 years of age or older with a cancer or benign diagnosis are 
eligible for the study. Patient can be recruited from the Principal investigator, co-
investigator or referring physicians’ clinical practices. Potential study subject 
should be referred to Principal investigator, co-investigator or study designated 
research nurse/associate. Principal investigator, co-investigator, or designated 
research nurse/associate will screen and determine the final eligibility of the 
subject for enrollment. 
 
4.5 Early Withdrawal of Subjects 
4.5.1 When and How to Withdraw Subjects 
Patients will be informed that they have the right to withdraw from the study at 
any time for any reason, without prejudice to their medical care. The investigator 
also has the right to withdraw patients from the study for any of the following 
reasons: 
1. Intercurrent illness 
2. Patient request 
3. Non-compliance 
4. Administrative reasons 
5. Patients may withdraw from the study voluntarily at any time;  
 
At the time of withdrawal, all study procedures outlined for the End of Study visit 
should be completed. The primary reason for a patient’s withdrawal from the 
study is to be recorded in the source documents. 
 
4.5.2 Data Collection and Follow-up for Withdrawn Subjects 
According to FDA regulations, when a subject withdraws from the study, the data 
collected on the subject to the point of withdrawal remains part of the study 
database and may not be removed. 

 
 
 
 
 
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A subject who is withdrawing needs to state whether he/she wishes to provide 
continued follow-up and further data collection subsequent to withdrawal from the 
interventional portion of the study.  
 
If a subject withdraws from the interventional portion of the study, but agrees to 
continued follow-up of associated clinical outcome information as described in the 
previous bullet, the subject will continue follow up visit and evaluation per the 
protocol. 
 
If a subject withdraws from the interventional portion of a study and does not 
consent to continued follow-up of associated clinical outcome information, study 
data related to the subject collected prior to the subject’s withdrawal from the 
study will included in the study analysis. However, the subject’s clinical data will 
not be used for dose escalation determination. 
 
5.0 STUDY DRUG/THERAPY  
5.1 Description 
Through the new Telehealth service provided by TJUH, patients are able to 
connect with TJUH doctors through a smartphone, tablet or computer to receive 
real-time care, such as on demand visits, scheduled online visits and remote 
second opinions, from any location convenient to them.  
 
In this trial, patients will receive their first post radiation treatment follow up as a 
virtual visit using Telehealth.  
 
5.2 Treatment Regimen 
Following obtaining informed consent, patients will return for their first post-
treatment visit as a virtual visit via Telehealth. During the visit the patients will 
use the application from their own home or any other off-campus location that is 
convenient for them. Patients will meet with a study representative to be 
introduced to the application.  
 
Following the visit, patients will be emailed to ask to complete a survey regarding 
their perceptions of the visit.  
 
5.3 Risks 
Risks of the study include potential anxiety caused to the patients  
 
5.4 Method for Assigning Subjects to Treatment Groups 

 
 
 
 
 
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This is a single arm study  
 
5.5 Preparation and Administration of Study Therapy 
Patients will be shown how to download the application to their electronic device 
and they will be instructed on the use of the application. A demonstration of the 
software will be done in the office to ensure patient understanding. A written hand 
out regarding application use will also be provided to the patients. Patients will 
receive follow up instructions including date and time of post-treatment visit.  
 
5.6 Subject Compliance Monitoring 
Compliance in the study is defined as subject return for post-treatment visit. 
Patients who fail to return for post-treatment visit will be deemed non-compliant. 
 
6.0 STUDY PROCEDURES 
6.1 Study Visit Schedule 
Screening: 
Potential candidates for the study will be identified by their treating radiation 
oncologist. Eligibility of patients will be verified based on eligibility criteria (section 
4.1). Those eligible patients will receive detailed information about the study.  
Patients will be informed of possible risk and benefits. Informed consent will be 
obtained from patients. Demographics and patient KPS will be assessed at the 
time of the screening visit 
 
Visit 1:  
Patients will undergo their first post-treatment visit as a virtual telehealth visit.  
Following the visit the treating physician will fill out the physician questionnaires 
on paper or online, while patients will be emailed a patient-specific link to a 
survey. Physicians will have 2 weeks following the date of the visit to complete 
the survey. Patients will have up to 4 weeks after the visit to complete the survey. 
Patients will receive weekly reminder emails regarding the survey up to 3 times 
after the visit. Patients will also have the option to fill out a paper survey 
(provided at the time of treatment discharge with the discharge instructions) and 
mail it into the office.  
 
Follow-up 
There will be no subsequent follow up  
 
6.1.1 Study Flowchart 

 
 
 
 
 
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Screening visit 
Post-treatment visit 
Sent to patient 
following visit 
Informed consent 
X 
 
 
Background 
information 
X 
 
 
KPS 
X 
 
 
Patient Satisfaction 
with Cancer Care 
Scaleb 
 
 
X 
Communication 
assessment toolb 
 
 
X 
Health care system 
distrust toolb 
 
 
X 
Physician 
questionnairea 
 
X 
 
Modified physician 
satisfaction scalea 
 
X 
 
a. Physicians are to complete surveys and satisfaction scale within 2 weeks 
following the visit.  
b. Patients are to complete surveys within 4 weeks following the visit. They 
will be emailed reminders weekly following the visit.  
 
7.0 STATISTICAL PLAN  
7.1 Sample Size Determination 
Accrual rate. This pilot study is designed to assess whether the accrual rate at 
Jefferson will be sufficient for a future noninferiority trial. For that noninferiority 
trial, we project that we will need to enroll a total of about 180 patients in three 
years, i.e., a minimum accrual rate of 5 patients per month. The enrollment 
duration of this pilot study will be 24 months. If the true accrual rate is 6 patients 
per month (i.e., 72 patients per year), then the pilot study has 83% power to 
establish that the accrual rate exceeds 5 patients per month (using a 1-sided test 
for Poisson rate, with alpha 0.05).  
 

 
 
 
 
 
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Patient satisfaction. The expected sample size of 60patients will also have 
>90% power to establish that patient satisfaction will exceed 80%, assuming a 
true PSCC score of about 90% and a standard deviation of about 5% (using a 
one-sample t-test with alpha 0.05). 
 
7.2 Statistical Methods 
The main analyses will focus on the monthly accrual rate (section 3.2). The 
number of patients accrued each month will be analyzed via Poisson regression. 
The mean (monthly rate) will be estimated and tested against the null value of 4 
patients per month using a 1-sided test with alpha 0.05. In addition to accrual, we 
will also summarize the proportion of enrolled subjects who are lost to follow-up, 
since that could also impact the feasibility of the future randomized trial. 
 
Additional analyses will focus on the secondary endpoints (section 3.3). For 
example, we will compute the average patient satisfaction score and test it 
against the null value of 75 using a one-sample t-test with alpha 0.05. We will 
also estimate the average patient rating of physician communication, patient 
distrust in the healthcare system, and physician satisfaction. 
 
7.3 Subject Population(s) for Analysis 
All enrolled subjects will be analyzed. Subjects who withdraw or are lost to follow-
up during the study will be counted in the accrual rate (since they will be part of 
the future randomized trial as per the intent-to-treat principle). 
 
8.0 DATA HANDLING AND RECORD KEEPING 
8.1 Confidentiality 
Information about study subjects will be kept confidential and managed according 
to the requirements of the Health Insurance Portability and Accountability Act of 
1996 (HIPAA). Those regulations require a signed subject authorization informing 
the subject of the following:  
● What protected health information (PHI) will be collected from subjects in 
this study 
● Who will have access to that information and why 
● Who will use or disclose that information 
● The rights of a research subject to revoke their authorization for use of 
their PHI.  
 
In the event that a subject revokes authorization to collect or use PHI, the 
investigator, by regulation, retains the ability to use all information collected prior 
to the revocation of subject authorization.  For subjects that have revoked 

 
 
 
 
 
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authorization to collect or use PHI, attempts should be made to obtain permission 
to collect at least vital status (i.e. that the subject is alive) at the end of their 
scheduled study period. 
 
8.2 Source Documents 
Source data is all information, original records of clinical findings, observations, 
or other activities in a clinical trial necessary for the reconstruction and evaluation 
of the trial. Source data are contained in source documents. Examples of these 
original documents, and data records include: hospital records, clinical and office 
charts, laboratory notes, memoranda, subjects’ diaries or evaluation checklists, 
pharmacy dispensing records, recorded data from automated instruments, copies 
or transcriptions certified after verification as being accurate and complete, 
microfiches, photographic negatives, microfilm or magnetic media, x-rays, 
subject files, and records kept at the pharmacy, at the laboratories, and at 
medico-technical departments involved in the clinical trial. 
 
8.3 Case Report Forms 
The study case report form (CRF) is the primary data collection instrument for the 
study. All data requested on the CRF must be recorded. All missing data must be 
explained.  If a space on the CRF is left blank because the procedure was not 
done or the question was not asked, write “N/D”. If the item is not applicable to 
the individual case, write “N/A”.  All entries should be printed legibly in black ink.  
If any entry error has been made, to correct such an error, draw a single straight 
line through the incorrect entry and enter the correct data above it.  All such 
changes must be initialed and dated. DO NOT ERASE OR WHITE OUT 
ERRORS. For clarification of illegible or uncertain entries, print the clarification 
above the item, then initial and date it. 
 
8.4 Records Retention 
It is the investigator’s responsibility to retain study essential documents for at 
least 2 years after the last approval of a marketing application in their country 
and until there are no pending or contemplated marketing applications in their 
country or at least 2 years have elapsed since the formal discontinuation of 
clinical development of the investigational product. These documents should be 
retained for a longer period if required by an agreement with the sponsor. In such 
an instance, it is the responsibility of the sponsor to inform the 
investigator/institution as to when these documents no longer need to be 
retained.  
 

 
 
 
 
 
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9.0 STUDY MONITORING, AUDITING, AND INSPECTING 
9.1 Study Monitoring Plan 
The investigator will allocate adequate time for monitoring activities. The 
Investigator will also ensure that the medical monitor or other compliance or 
quality assurance reviewer is given access to all the above noted study-related 
documents and study related facilities (e.g. pharmacy, diagnostic laboratory, 
etc.), and has adequate space to conduct the monitoring visit. 
 
9.2 Auditing and Inspecting 
The investigator will permit study-related monitoring, audits, and inspections by 
the IRB, the funding sponsor, government regulatory bodies, and University 
compliance and quality assurance groups of all study related documents (e.g. 
source documents, regulatory documents, data collection instruments, study data 
etc.). The investigator will ensure the capability for inspections of applicable 
study-related facilities (e.g. pharmacy, diagnostic laboratory, etc.). 
 
Participation as an investigator in this study implies acceptance of potential 
inspection by government regulatory authorities and applicable University 
compliance and quality assurance offices. 
 
9.2.1 Independent External and Internal Audits  
In addition to review by the DSMC, all studies initiated by SKCC investigators are 
audited by an independent auditor once they have achieved 10% of target 
accrual. However, a study can be audited at any time based on 
recommendations by the IRB, DSMC, PRC and/or the Director of Clinical 
Investigations, SKCC. Studies are re-audited once they have achieved 50% of 
target accrual. Special audits may be recommended by the IRB, DSMC or PRC 
based on prior findings, allegations of scientific misconduct and where significant 
irregularities are found through quality control procedures. Any irregularities 
identified as part of this process would result in a full audit of that study.  
 
In addition to the audits at 10 and 50%, the CTO randomly audits at least 10 
percent of all patients entered into therapeutic SKCC trials and other trials as 
necessary, on at least a bi-annual basis, to verify that there is a signed and dated 
patient consent form, the patient has met the eligibility criteria, and that SAEs are 
documented and reported to the TJU IRB.  
 
All audit reports are submitted to the DSMC for review and action (when 
appropriate). A copy of this report and recommended DSMC action is sent to the 
PRC and TJU IRB. The committee regards the scientific review process as 

 
 
 
 
 
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dynamic and constructive rather than punitive. The review process is designed to 
assist Principal Investigators in ensuring the safety of study subjects and the 
adequacy and accuracy of any data generated. The TJU IRB may, based on the 
DSMC and auditor’s recommendation, suspend or terminate the trial.  
 
10.0 ETHICAL CONSIDERATIONS 
This study is to be conducted according to US and international standards of 
Good Clinical Practice (FDA Title 21 part 312 and International Conference on 
Harmonization guidelines), applicable government regulations and Institutional 
research policies and procedures. 
 
This protocol and any amendments will be submitted to a properly constituted 
independent Institutional Review Board (IRB), in agreement with local legal 
prescriptions, for formal approval of the study conduct.  The decision of the IRB 
concerning the conduct of the study will be made in writing to the investigator 
before commencement of this study.   
 
All subjects for this study will be provided a consent form that is compliant with 
local and federal regulations, describing this study and providing sufficient 
information for subjects to make an informed decision about their participation in 
this study.  See Attachment for a copy of the Subject Informed Consent Form.  
This consent form will be submitted with the protocol for review and approval by 
the IRB for the study.  The formal consent of a subject, using the IRB-approved 
consent form, must be obtained before that subject is submitted to any study 
procedure.  This consent form must be signed by the subject or legally 
acceptable surrogate, and the investigator-designated research professional 
obtaining the consent.  
 
11.0 STUDY FINANCES 
11.1 Funding Source 
This study is unfunded. 
 
11.2 Conflict of Interest 
Any investigator who has a conflict of interest with this study (patent ownership, 
royalties, or financial gain greater than the minimum allowable by their institution, 
etc.) must have the conflict reviewed by a properly constituted Conflict of Interest 
Committee with a Committee-sanctioned conflict management plan that has 
been reviewed and approved by the study sponsor prior to participation in this 
study.  All Jefferson University Investigators will follow the TJU Conflicts of 
Interest Policy for Employees (107.03). 

 
 
 
 
 
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12.0 PUBLICATION PLAN 
All investigators involved in the portion of the trial being published will review 
manuscripts prior to publication.  The Principal Investigator will be ultimately 
responsible for the content of all manuscripts. 
 
13.0 REFERENCES 
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routine  follow-up clinics after radiotherapy for cancer: A report of the REACT 
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treatment for breast cancer: Views and experiences of patients and specialist 
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5. Cunniffe NG, Robson J, Mazhar D, Williams MV. Clinical examination does not 
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6. Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to 
face patient care: effects on professional practice and health care outcomes.  
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7. Dickinson R, Hall S, Sinclair JE, Bond C, Murchie P. Using technology to 
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14-311. 
8. Faithfull S, Corner J, Meyer L, Huddart R, Dearnaley D. Evaluation of nurse-
led follow up for patients undergoing pelvic radiotherapy. Br J Cancer 2001; 
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9. Gotay CC and Bottomley A. Providing psycho-social support by telephone: 
What is its potential in cancer patients? Eur J Cancer Care (Engl) 1998; 7(4):225-
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10. James ND, Guerrero D, Brada M. Who should follow up cancer patients? 
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11. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for 
non-metastatic colorectal cancer. Cochrane Database Syst Rev 2007; 
(1)(1):CD002200. 

 
 
 
 
 
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12.Kimman ML, Bloebaum MM, Dirksen CD, Houben RM, Lambin P, Boersma 
LJ. Patient satisfaction with nurse-led telephone follow-up after curative 
treatment for breast cancer. BMC Cancer 2010; 10:174,2407-10-174. 
12. Mair F and Whitten P. Systematic review of studies of patient satisfaction with 
telemedicine. BMJ 2000; 320(7248):1517-20. 
13. Montgomery DA, Krupa K, Cooke TG. Follow-up in breast cancer: Does 
routine clinical examination improve outcome? A systematic review of the 
literature. Br J Cancer 2007;  97(12):1632-41. 
14. Sardell S, Sharpe G, Ashley S, Guerrero D, Brada M. Evaluation of a nurse-
led telephone clinic in the follow-up of patients with malignant glioma. Clin Oncol 
(R Coll Radiol) 2000; 12(1):36-41. 
15. Shaida N, Jones C, Ravindranath N, Das T, Wilmott K, Jones A, Malone PR. 
Patient satisfaction with nurse-led telephone consultation for the follow-up of 
patients with prostate cancer. Prostate Cancer Prostatic Dis 2007; 10(4):369-73. 
16. Smits A, Lopes A, Das N, Bekkers R, Kent E, McCullough Z, Galaal K. 
Nurse-led telephone follow-up: Improving options for women with endometrial 
cancer. Cancer Nurs 2015; 38(3):232-8. 
17. Teagle A and Gilbert DC. Remote follow-up strategies after cancer treatment: 
A lot of opportunities. Clin Oncol (R Coll Radiol) 2014; 26(10):622-4. 
18. Van Hezewijk M, Ranke GM, van Nes JG, Stiggelbout AM, de Bock GH, van 
de Velde CJ. Patients' needs and preferences in routine follow-up for early breast 
cancer; an evaluation of the changing role of the nurse practitioner. Eur J Surg 
Oncol 2011; 37(9):765-73. 
19. Molina et al. Medical mistrust and patient satisfaction with mammography: 
the mediating effects of perceived self-efficacy among navigated African 
American Women. Health Expect 2014 epub ahead of print 
20. Gabitova et al. Improving healthcare empowerment through breast cancer 
patient navigation: a mixed methods evaluation in a safety-net setting. BMC 
Health Serv Res 2014; 14:407 
21. Pierre et al. Do better-rated navigators improve patient satisfaction with 
cancer related care? J Cancer Educ 2013; 28:527-34 
22. Fiscella et al. Patient navigation for breast and colorectal cancer treatment: a 
randomized trial. Cancer Epidemiol Biomarkers Prev 2012; 21:1673-81 
23. Makoul et al. Measuring patient views of physician communication skills: 
Development and testing of the Communication Assessment Tool. Patient Educ 
Couns. 2007; 67:333-42 
24. Kuroki L et al. Disclosing a diagnosis of cancer: considerations specific to 
gynecologic oncology patients. Obstet Gynecol 2013; 122:1033-9 

 
 
 
 
 
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25. Mandelblatt et al. Patient and physician decision styles and breast cancer 
chemotherapy use in older women: CALGB 369901. J Clin Oncol 2012; 30:2609-
14 
26. Nunes et al. Associations among perceived and objective disease knowledge 
and satisfaction with physician communication in patients with chronic kidney 
disease. Kidney Int 2011; 80:1344-51 
27. Yeh et al. Dense breast tissue notification: impact on Women’s perceived 
risk, anxiety and intentions for future breast cancer screening. J Am Coll Radiol 
2015; 12:261-6  
28. Earl et al. Race, relationships and trust in providers among black patients 
with HIV/AIDS. Soc Work Res 2013; 37:219-226 
29. Haywood et al. Attitudes toward clinical trials among patients with sickle cell 
disease. Clin Trials 2014; 11:275-283 
30. Nonzee et al. Design of a prostate cancer patient navigation intervention for a 
VA hospital. BMC Health Serv Res 2012; 12:340 
32. Livingstone J, Solomon J. An assessment of the cost-effectiveness, safety of 
referral and patient satisfaction of a general practice teledermatology service. 
London J Prim Care. 2015; 7(2):31-5 
33. Rose A et al. Development and testing of the health care system distrust 
scale. J Gen Intern Med 2004; 19:57-63 
34. Allen et al., A pilot study of physician acceptance of tele-oncology J Telemed 
Telecare 1995; 1:34-7 
35. Craig, John, and Victor Patterson. "Introduction to the practice of 
telemedicine." Journal of Telemedicine and Telecare 11.1 (2005): 3-9. 
36. Mair, Fiona et al. "The added value of video for consultations in telemedicine 
for minor injuries work." Journal of telemedicine and telecare 17.8 (2011): 427-
431. 
37. Pedragosa, Àngels et al. "Impact of a telemedicine system on acute stroke 
care in a community hospital." Journal of telemedicine and telecare 15.5 (2009): 
260-263. 
38. Terkelsen, CJ et al. "Telemedicine used for remote prehospital diagnosing in 
patients Thomas, Martin, and Ian Crawford. Journal of internal medicine 252.5 
(2002): 412-420. 
39.Ward, Marcia M, Mirou Jaana, and Nabil Natafgi. "Systematic review of 
telemedicine applications in emergency rooms." International Journal of Medical 
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40. Amadi-Obi, Ahjoku et al. "Telemedicine in pre-hospital care: a review of 
telemedicine applications in the pre-hospital environment." International journal of 
emergency medicine 7.1 (2014): 1-11. 
41.Brennan, John A et al. "A randomized controlled trial of telemedicine in an 
emergency department." Journal of telemedicine and telecare 4.suppl 1 (1998): 
18-20. 
42.Herrington, Garth, Yvonne Zardins, and Alan Hamilton. "A pilot trial of 
emergency telemedicine in regional Western Australia." Journal of telemedicine 
and telecare 19.7 (2013): 430-433. 
43.Currell, Rosemary et al. "Telemedicine versus face to face patient care: 
effects on professional practice and health care outcomes." Cochrane Database 
Syst Rev 2.2 (2000). 
 
14.0 APPENDICES  
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
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Appendix I: Karnofsky Performance Scale 
 
Able to carry on normal activity and to 
work; no special care needed. 
  100   Normal no complaints; no 
evidence of disease. 
90 
Able to carry on normal activity; 
minor signs or symptoms of 
disease. 
80 
Normal activity with effort; some 
signs or symptoms of disease. 
Unable to work; able to live at home and 
care for most personal needs; varying 
amount of assistance needed. 
70 
Cares for self; unable to carry on 
normal activity or to do active 
work. 
60 
Requires occasional assistance, 
but is able to care for most of his 
personal needs. 
50 
Requires considerable 
assistance and frequent medical 
care. 
Unable to care for self; requires 
equivalent of institutional or hospital 
care; disease may be progressing 
rapidly. 
40 
Disabled; requires special care 
and assistance. 
30 
Severely disabled; hospital 
admission is indicated although 
death not imminent. 
20 
Very sick; hospital admission 
necessary; active supportive 
treatment necessary. 
10 
Moribund; fatal processes 
progressing rapidly. 
0 
Dead 
 
 
 
 
Appendix II. Case Report Forms 

 
 
 
 
 
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TELEPORT Study Case Report Form (CRF)—Screening Visit 
Date of Screening: 
 
 
 
 
Patient Demographics 
Age: 
 
 
Race:  
 
 
 
 
 
 
 
 
Current Email Address: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Marital Status: 
 
 
 
 
 
 
 
 
Highest Education Level Completed:  
 
 
 
 
 
Karnofsky Performance Status: 
Please assess the patient’s performance status based on the table provided. Circle the 
most appropriate functional capacity. 
Able to carry on normal activity and to work; no 
special care needed. 
  100   Normal no complaints; no evidence of 
disease. 
90 
Able to carry on normal activity; minor 
signs or symptoms of disease. 
80 
Normal activity with effort; some signs or 
symptoms of disease. 
Unable to work; able to live at home and care for 
most personal needs; varying amount of 
assistance needed. 
70 
Cares for self; unable to carry on normal 
activity or to do active work. 
60 
Requires occasional assistance, but is 
able to care for most of his personal 
needs. 
50 
Requires considerable assistance and 
frequent medical care. 
Unable to care for self; requires equivalent of 
institutional or hospital care; disease may be 
progressing rapidly. 
40 
Disabled; requires special care and 
assistance. 
30 
Severely disabled; hospital admission is 
indicated although death not imminent. 
20 
Very sick; hospital admission necessary; 
active supportive treatment necessary. 
10 
Moribund; fatal processes progressing 
rapidly. 
0 
Dead 
 
 
 

 
 
 
 
 
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TELEPORT Inclusion/Exclusion Criteria Checklist 
Inclusion Criteria: 
Patients must meet all of the following criteria in order to be considered for entry into the 
TELEPORT trial. 
7. Patients who underwent, currently undergoing or planned to start radiation 
treatment in the next month with curative, adjuvant or palliative intent who have 
not yet had their first post-treatment visit 
• 
Age ≥ 18  
• 
Karnofsky performance status at least 60%  
• 
Able to read and speak English and provide study specific informed consent prior 
to study entry  
• 
Have access to a computer or smartphone and internet connection at home on 
which they would be willing to do a telehealth study  
• 
Pennsylvania or  New Jersey residents* 
 
*Telehealth visits for New Jersey residents will only be performed by physicians 
with a current medical license issued by the state of New Jersey: 
 
Nicole Simone, MD* 
Adam Dicker MD PhD* 
Voichita Bar Ad MD* 
Wenyin Shi MD* 
Robert Den MD* 
Mark Hurwitz MD* 
 
Exclusion Criteria: 
In addition to meeting inclusion criteria, patients are ineligible for enrollment if any of the 
following exclusion criteria are met. 
• 
Patients under the age of 18 
• 
KPS <60% 
• 
No access to a computer, smartphone or internet  
• 
Unable to read and/or speak English 
• 
Decisionally impaired patients 
• 
Patients not residing in Pennsylvania or New Jersey 
 
Checklist for Screening Visit: 
 
Informed Consent for Trial Obtained 
 
All Sections of CRF Completed 
 
Inclusion/Exclusion Criteria Evaluated 
 
Based on screening patient appears eligible 
 
 
 
 

 
 
 
 
 
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TELEPORT Study Case Report Form (CRF)—Follow up Visit 
Patient Satisfaction with Cancer Care Scale (PSCC) 
Below is a list of statements regarding your recent post-treatment visit. Please indicate 
your response 
 
Strongly 
agree 
(1) 
Agree 
 
(2) 
Neutral  
 
(3) 
Disagree 
 
(4) 
Strongly 
disagree 
(5) 
I felt my concerns were understood 
 
 
 
 
 
I felt I was treated with courtesy and respect  
 
 
 
 
 
I felt included in decisions about my health 
 
 
 
 
 
I was told how to take care of myself 
 
 
 
 
 
I felt encourages to talk about my personal health 
concerns 
 
 
 
 
 
I felt I had enough time with my doctor 
 
 
 
 
 
My questions were answered to my satisfaction 
 
 
 
 
 
Making an appointment was easy 
 
 
 
 
 
I knew what the next step in my care would be 
 
 
 
 
 
I feel confident in how I deal with the health care 
system 
 
 
 
 
 
I was able to get the advice I needed about my 
health issues 
 
 
 
 
 
I knew who to contact when I had a question 
 
 
 
 
 
I received all the services I needed 
 
 
 
 
 
I am satisfied with the care I received 
 
 
 
 
 
The doctors seemed to communicate well about my 
care 
 
 
 
 
 
I received high quality care from my regular doctor 
 
 
 
 
 
I received high quality care from my specialists 
 
 
 
 
 
My regular doctor was informed about the results of 
the tests I got 
 
 
 
 
 

 
 
 
 
 
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Communication assessment tool (CAT) 
Please use this scale to rate the way the doctor communicated with you.  
 
 
Poor 
(1) 
Fair 
(2) 
Good 
(3) 
Very good 
(4) 
Excellent 
(5) 
Greeted me in a way that made me feel 
comfortable 
 
 
 
 
 
Treated me with respect 
 
 
 
 
 
Showed interest in my ideas about my 
health 
 
 
 
 
 
Understood my main health concerns 
 
 
 
 
 
Paid attention to me(looked at me, 
listened carefully) 
 
 
 
 
 
Let me talk without interruptions 
 
 
 
 
 
Gave me as much information as I 
wanted 
 
 
 
 
 
Talked in terms I could understand 
 
 
 
 
 
Checked to be sure I understood 
everything 
 
 
 
 
 
 Encouraged me to ask questions 
 
 
 
 
 
Involved me in decisions as much as I 
wanted 
 
 
 
 
 
Discussed net steps, including any follow 
up plans 
 
 
 
 
 
Showed care and concern 
 
 
 
 
 
Spent the right amount of time with me 
 
 
 
 
 
 
 
 

 
 
 
 
 
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Health care system distrust scale 
The next questions are about your opinion of the health care system in general. 
When we refer to the health care system, we mean hospitals, health insurance 
companies, and medical research. For each statement below, please indicate 
how strongly you agree or disagree 
 
 
Strongly 
agree 
(5) 
Agree 
 
(4) 
Not sure  
 
(3) 
Disagree 
 
(2) 
Strongly 
disagree 
(1) 
Medical experiments can be done to me 
without my knowing about it 
 
 
 
 
 
My medical records are kept private 
 
 
 
 
 
People die every day because of 
mistakes by the health care system 
 
 
 
 
 
When they take my blood, they do tests 
they don’t tell me about 
 
 
 
 
 
If a mistake were made in my health 
care, the health care system would try to 
hide it from me 
 
 
 
 
 
People can get access to my medical 
records without my approval 
 
 
 
 
 
The health care system cares more 
about holding costs down than it does 
about doing what is needed for my heath 
 
 
 
 
 
I receive high-quality medical care from 
the health care system 
 
 
 
 
 
The health care system puts my medical 
needs above all other considerations 
when treating my medical problems 
 
 
 
 
 
Some medicines have things in them that 
they don’t tell you about 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
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Physician questionnaire 
 
Yes 
No 
Not applicable 
Were you able to assess 
the patient’s symptoms? 
 
 
 
Were you comfortable 
assessing treatment 
related toxicity? 
 
 
 
Was a medication 
assessment done? 
 
 
 
Was KPS assessed and 
documented? 
 
 
 
If this was a telehealth 
visit, did you feel the 
need to bring the patient 
in to the office for further 
evaluation? 
 
 
 
Was patient provided 
with follow up 
instructions at the end of 
the visit? 
 
 
 
Was patient asked about 
follow up with other 
providers? 
 
 
 
Was patient provided 
with follow up labs 
and/or imaging 
instructions? Yes 
 
 
 
How long did today’s 
visit take? 
Today’s visit took approximately _____________ minutes 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
Version 6.0 (2017-10-16) 
 
Modified physician satisfaction scale 
 
Strongly 
agree 
(5) 
Agree 
 
(4) 
Not sure  
 
(3) 
Disagree 
 
(2) 
Strongly 
disagree 
(1) 
I was able adequately to review this 
patient’s laboratory results 
 
 
 
 
 
I was able adequately to review this 
patient’s imaging 
 
 
 
 
 
I was able to elicit an adequate history 
from this patient 
 
 
 
 
 
I was able to communicate facts 
adequately to this patient 
 
 
 
 
 
I think this patient was satisfied with this 
clinical encounter 
 
 
 
 
 
My ability to evaluate this patient was 
significantly hampered because s/he was 
seen via televideo rather than in person  
 
 
 
 
 
It was as easy to ask intimate questions 
today as it would have been in person  
 
 
 
 
 
In general, I found the televideo system 
frustrating to use 
 
 
 
 
 
Compared with an in-person clinical 
encounter, I felt less sure that I was 
getting all of the information I needed 
 
 
 
 
 
I would like to use the televideo system 
again