Planning an enhanced telemedicine program for prostate cancer care: A qualitative assessment of patients,’ clinicians’, and other key stakeholders' interest and needs.
Authors: Bange Erin Mary , Stevanovic Kristina , Lipitz-Snyderman Allison , Morris Michael J. , Kuperman Gilad , Polubriaginof Fernanda C. G. , Stetson Peter D. , Schrag Deborah , Panageas Katherine , Chimonas Susan 
Published: October 2023

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Background: The current model of prostate cancer care demands patients to frequent the clinic for monitoring and treatment, causing significant time and financial burdens. Advances in technology, mobile phlebotomy, and oral/injection-based treatments now enable the development of an enhanced telemedicine (ET) care model. This model incorporates three essential components that can be done at home: 1) monitoring vital signs, 2) conducting blood draws, and 3) administering medication. To optimize the design and implementation of this ET program at Memorial Sloan Kettering Cancer Center (MSKCC), a high-volume cancer center in NYC, we evaluated the viewpoints of patients, clinicians, and other key stakeholders’ perspectives. Methods: An experienced qualitative researcher (SC) conducted semi-structured interviews via Zoom, exploring stakeholders’ interest in and needs around an ET program. Prostate cancer patients treated at MSKCC with androgen deprivation therapy and/or oral therapies were eligible for inclusion. Purposive sampling of clinical and administrative staff minimized oversampling. Enrollment continued until thematic saturation was achieved. Transcripts were recorded, transcribed, and coded using standardized protocols. Results: 26 stakeholders participated: 9 patients, 8 physicians (MDs), 4 administrators, 3 registered nurses (RNs), and 2 pharmacists. 8/9 (89%) patients felt able to participate in all 3 at-home components either alone or with caregiver support; 4/8 (50%) MDs reported that >50% of their patients could be appropriate for the program. Across all stakeholder groups, participants expressed the need for quality assurance, troubleshooting protocols, safeguards for drug administration errors, and alerting parameters for lab and vitals measurements. 4/8 MDs and 1/3 RNs also emphasized the need to promote communication and protect the patient-clinician relationship. Clinical and administrative staff highlighted the importance of ideal-patient selection, training protocols, attention to MD and staff workloads, and selection of appropriate agents for self-injection (i.e., subcutaneous versus intramuscular injections), while some patients raised privacy concerns. When asked how likely they were to participate in the program, 16 (62%) participants reported being very likely (6 patients, 5 MDs, 1 pharmacist, 4 admin), 7 somewhat likely (1 patient, 2 MDs, 3 RNs, 1 pharmacist), 1 somewhat unlikely (1 patient), and 2 very unlikely (1 patient, 1 MD). Conclusions: Patients, clinicians, and administrators are enthusiastic about engaging in an ET care model. It is essential to conduct additional research to evaluate the implementation, quality of care, and other critical factors necessary for developing and disseminating a successful care model that can be applied across various institutions.