Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care

Abstract

Objectives Identify which delivery modality for skin reconstruction care, face‐to‐face (FTF) in‐person versus two telemedicine modalities, store‐and‐forward (S&F) and live video chat (LVC), is patient preferred and how cost, access, wait time, and demographics influence this preference. Study Design Cross‐sectional survey. Methods A 16‐question survey querying demographics and five scenario‐specific preferences questions for the delivery of skin cancer reconstruction care was created and distributed via Amazon Mechanical Turk (MTurk), a crowdsourcing online marketplace, and in‐person to Mohs micrographic surgery patients. Results 1394 MTurk and 55 in‐person responses were included. While 82.1% of online respondents prefer FTF clinic visits, this decreases to 58.3% with an in‐person visit cost (p < 0.01) and furthermore to a minority 43.5% with both an in‐person visit cost and wait time (p < 0.01) despite 77.8% believing that usefulness to the surgeon would improve FTF. Both the MTurk and in‐person cohorts demonstrated similar response patterns despite considerable demographic differences. Multivariable analyses revealed that telemedicine was preferred by MTurk respondents with Medicaid (adjusted OR [95% CI]: 1.97 [1.18–3.31]) or Medicare (1.69 [1.10–2.59]) versus private insurance, and prior skin cancer (2.01 [1.18–3.42]) and less preferred by those earning $140,000+ per year (0.49 [0.29–0.82]) compared to those earning <$20,000 per year. Conclusions FTF visits are preferred for skin cancer reconstruction care; this shifts toward virtual care with a cost and wait time in spite of the perceived quality of care. Individuals with socioeconomic barriers to access prefer telemedicine. MTurk can be a valuable tool for behavioral research in FPRS. Level of Evidence NA Laryngoscope, 133:294–301, 2023

The role of teledermatology in Mohs micrographic surgery: a review

“…Du et al analyzed 1,449 participants’ preferences for TD versus FTF consultations for MMS, which included 1,394 Amazon Mechanical Turk (MTurk) responses and 55 in-person surveys [ 7 ]. While 82.1% of MTurk respondents preferred FTF, this preference decreased to 58.3% with a $100 cost ( p < 0.01) and further to 43.5% with both a $100 cost and an hour wait time for FTF, compared to a $50 cost for TD ( p < 0.01).…”

“…TD is more preferred by Medicaid or Medicare beneficiaries, previous skin cancer patients, and lower-income groups, indicating its appeal to those facing socioeconomic barriers to healthcare access. Ultimately, patients prefer FTF appointments for skin cancer reconstruction care, but this preference shifts towards TD when considering increased costs and longer waiting times [ 7 ]. However, the study’s method of assessing travel burden, which used patient-selected town type and rurality as proxies, may not accurately reflect actual travel distances and costs.…”

“…However, the study’s method of assessing travel burden, which used patient-selected town type and rurality as proxies, may not accurately reflect actual travel distances and costs. Additionally, while the survey results are consistent with those from the online cohort, the external validity of conclusions drawn from multivariable analyses remains uncertain [ 7 ].…”

“…Some studies have demonstrated its effectiveness in reducing wait times, CFR, and travel burdens for patients. 6,7 However, the benefits of TD are largely related to logistical aspects rather than direct improvements in surgical or clinical outcomes [7]. Notably, patients facing socioeconomic barriers to healthcare access showed a strong preference for TD highlighting its potential to bridge healthcare disparities.…”