Abstract SS2-09: Telemedicine usability for cancer care during the COVID-19 pandemic
Authors: Leon Andrea , Kaltman Rebecca , Arem Hannah , Amdur Richard , Gesteira Andrea , Duffy Samuel , Miller Christian , Burgess Brooke , Morecock Christiane 
Published: February 2021

Background Healthcare delivery via telemedicine has increased substantially amid COVID-19. The George Washington Cancer Center (GWCC) now provides cancer care services via tele-visits for patients at high risk of morbidity and mortality secondary to COVID-19. This study was performed to assess usability of virtual cancer care delivery for patients and providers across specialties.

Methods Participants included patients and providers surveyed to assess baseline usability after initiating tele-visits. Surveys included demographics, Telehealth Usability Questionnaire (TUQ), and questions on perceived safety and preferences around telemedicine. Subjects also provided open-ended feedback for quality improvement.

Results For patients (n=133), 93% of surveys sent were completed and analyzed. Most patients were between ages 60-69 (26%), 70-79 (24%), 50-59 (22%). Breast cancer (41%) was the most commonly reported cancer type. Mean patient TUQ scores based on a 5-point scale (1-strongly disagree, 5 - strongly agree) were: 4.4 for Interface Quality (IfQ), 4.3 for Ease of Use (EU), 4.2 for Usefulness (U) and Satisfaction (S), 4.1 for Interaction Quality (ItQ), 3.4 for Reliability (R). No association was found between mean TUQ scores and age groups (p=0.33), sex (p=0.79), timing of diagnosis in relation to telemedicine visit (p=0.67), stage of diagnosis (p=0.98), or treatment type (p=0.65). However, patients with more telemedicine visits did score significantly higher in Reliability (P=0.018) and Satisfaction (P=0.039), compared to those with fewer telemedicine visits.

Compared to in-person visits, 77% of patients agreed/strongly agreed that telemedicine made them feel safer, 75% agreed/strongly agreed that it reduced stress, and 72% expressed interest in using it with other medical specialties.

For providers (n=109), 84% of surveys sent were completed and analyzed. Most providers were between ages 30-39 (33%) or 40-49 (21%), and 41% had 50 or more experiences with telemedicine. The predominant specialty participating was Internal Medicine (27%). Mean provider TUQ scores were 4.3 for U, 4.1 for S, 3.8 for EU, 3.7 for ItQ, 3.6 for IfQ, and 2.7 for R. No association was found between mean TUQ scores and experience with telemedicine (p=0.31), age groups (p=0.06), or specialty (p=0.53). However, providers with more experiences with telemedicine scored significantly higher in Satisfaction (p=0.01) and Usefulness (p=0.02).

The majority of providers (97%) agreed/strongly agreed that telemedicine improves access to care, yet 59% expressed concern about missing something they may have caught in person. Furthermore, older providers generally had lower reliability scores compared to younger providers (p=0.03), and also showed generally greater concern about losing personal interface with patients with the use of telemedicine than younger providers (p= 0.006).

Conclusion

The utility of telemedicine in cancer care during the COVID-19 pandemic was perceived favorably by both patients and providers. All patient groups scored highly on perceived safety, reduced stress and improved access, independently of subject characteristics. Older providers were more wary of the reliability of telemedicine and its effects on patient-provider relationships. These findings provide a useful benchmark for advancement of virtual care delivery in cancer care, beyond the COVID-19 pandemic.

Citation Format: Andrea Leon, Rebecca Kaltman, Hannah Arem, Richard Amdur, Andrea Gesteira, Samuel Duffy, Christian Miller, Brooke Burgess, Christiane Morecock. Telemedicine usability for cancer care during the COVID-19 pandemic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-09.