Equity considerations in the accessibility of virtual visits in the oncology setting.
Authors: Elston Lafata Jennifer Elston , Barrow Lauren CJ , Fridman Ilona , Kinlaw Alan C , Royce Trevor Joseph , Smith Angela B. , Stein Jacob Newton , Tam Samantha , Wood William Allen , Neslund-Dudas Christine 
Published: October 2023

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Background: With COVID-19, virtual visits (VV) were introduced in many oncology practices. Although use has declined since the height of the pandemic, many practices continue to offer VVs. To inform understanding of how VVs impact racial equity within oncology, we evaluated oncology patients’ perceptions of VV use in cancer care. Methods: Using electronic health records at an academic medical center and affiliated practices, we identified adults aged 21+ who received cancer treatment in the past three years. We approached all patients with scheduled cancer-related VVs and randomly selected samples of those with cancer-related in-person visits between 4/22-4/23, oversampling Black adults. Eligible participants received a letter of study introduction, followed by telephone call(s) to invite study participation. Qualitative interview results and the Technology Acceptance Model guided survey content. Respondents received a $25 gift card incentive. We evaluated racial differences in care preferences, perceived usefulness, and barriers related to ease of use, using Chi-square and t-tests, as appropriate. Results: 498 patients completed a pre-visit survey (response rate=24%). For 460 respondents, self-identified race was Black (n=174) or White (n=286) and concordant with socially identified race. Among those, mean age was 63 years (SD=13); 65% female, 59% married, 51% college educated, and 13% reported income-related difficulties. 30% rated their health as Excellent/Very Good, 42% Good, and 28% Fair/Poor. Black adults were significantly (p<0.01) more likely to be younger, have no college education, be unmarried, have income difficulties, and fair/poor health. Black respondents were significantly (p<0.01) less likely to be scheduled for a VV (5% v. 20%) and report ever having a VV for cancer care (34 v 52%). We found no significant differences by race (p<0.05) in being offered a choice in visit format (14 v 19%), or perceived VV usefulness for determining health needs (54 v 61%), asking questions (84 v 90%), reporting symptoms (84 v 89%), and getting staff help (74 v 73%). Black adults were significantly (p<0.01) less likely to report driving themselves to doctor’s appointments (62 v 73%), and more likely to agree that VVs were useful for involving family and friends (64 v 53%). Black patients were significantly (p<0.01) more likely to report VV connectivity-related concerns, including worry regarding internet (25 v 15%) and device (17 v 8%) access, and not having someone to help with connectivity (24 v 12%). Conclusions: Our findings elucidate the challenge facing oncology practices wishing to offer VVs simultaneously with ensuring equity in care access. We found Black patients, despite presenting with additional health and social needs, perceived benefits from VVs, but also concerns regarding VV accessibility, and thus likely in need of practice-support for equitable VV access in cancer care.