Differences in perceptions and use of remote patient monitoring technology in rural cancer programs.
Authors: Penberthy David , Offit Caroline , Mangir Christina , Boehmer Leigh , King-Kallimanis Bellinda , Sedhom Ramy , Smith Cardinale B. , Patel Smit , Kendall Jeffrey , Hunnicutt Jeff , Dean Martin Amanda G. , Pierce Erin , Rainey Anne Marie , Dicker Adam P. , Fecenko-Tacka Karen 
Published: June 2023

1582 Background: While the benefits and acceptability of remote patient monitoring (RPM) during cancer care are well documented, barriers to implementation and use of these digital technologies remain. Feasibility may be particularly restricted in rural settings. The Association of Community Cancer Centers (ACCC) surveyed U.S. cancer programs, patients with cancer and caregivers in various geographic settings to illuminate the current practice landscape and perceptions regarding the use of digital technologies to monitor patients for adverse events and collect patient reported outcomes (PROs). Methods: ACCC convened an expert advisory committee and patient advocacy partners to guide development of two surveys, one for cancer program staff and the other for patients/caregivers. Surveys were distributed between December 2022 and January 2023 and included 25 closed and open-ended questions. Exploratory analysis was performed and responses were compared between rural, suburban, and urban settings for both groups, with comparisons made by two tailed Fisher’s exact test. Results: There were 128 cancer program staff and 162 patient/caregiver responses. Of staff respondents (52% physicians, 20% other clinicians, 21% administrators/managers), 58% work in urban, 30% suburban, and 13% rural settings. Of the patient/caregiver respondents (56% patients, 44% caregivers), 28% live in urban, 51% suburban, and 21% rural areas. 56% of rural, 24% of urban, and 26% of suburban respondents indicated that their cancer programs have not implemented and are not considering implementing RPM. Of rural program staff, 44% indicated they have no experience/familiarity with RPM, compared to 7% for urban and 13% for suburban staff (p<.001, p=.03, respectively). Fewer rural programs, as compared to urban, use secure text messaging (6% vs. 42%; p=.008) or automated phone surveys (6% vs. 34%; p=.03). More rural patients/caregivers compared to their urban/suburban counterparts indicated concerns about privacy (47% vs 27%; p=.02), concerns about the need to pay (44% vs. 19%; p=.004), and lack of strong cell service (21% vs 5%; p=.007) as barriers to RPM technology use. Conclusions: RPM is gaining momentum in academic and community cancer program settings; however, significant gaps exist in RPM experience and implementation for rural cancer programs. In addition to well-documented disparities in access to internet and cellular service for rural patients, perceptions about privacy and cost pose additional barriers. Secure text messaging and automated surveys are often used as example solutions to bridge digital literacy and access gaps, yet cancer programs in rural areas are less likely to use these technologies. Tailored patient/provider education, funding/reimbursement strategies, and advocacy for policies expanding technology infrastructure may be needed for cancer programs to equitably provide RPM technologies.