Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study

Abstract

Purpose Telemedicine was rapidly implemented for initial consultations and radiation treatment planning in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we explore utilization of and physician perspectives on this approach in an attempt to identify patient populations that may benefit most from virtual care. Methods and Materials This is a mixed-methods study with a convergent design. Approximately 6 to 8 weeks after implementation of telemedicine, all radiation oncologists in a single academic radiation oncology department were invited to participate in either semistructured interviews with embedded survey questions or a concurrently administered survey only. Rapid qualitative analysis was used to identify common themes, and quantitative data was assessed using descriptive statistics and univariable analyses. Results At the apex of the pandemic, 92% of radiation oncology visits were conducted via telemedicine. In total, 51 of 61 radiation oncologists participated in the study (response rate 84%). Most (71%) reported no difference in ability to treat cancer appropriately via telemedicine, which was more common among specialized physicians ( P = .01) but not those with higher visit volume or years of experience. Over half (55%) perceived no difference or even improvement in overall visit quality with telemedicine. Virtual visits were deemed acceptable for a median of 70% to 96% of patients, which varied by disease site. Need for physical examination, and availability of an acceptable proxy, factored into telemedicine acceptability. Most (88%) found telemedicine better than expected, but opinions were split on how telemedicine would affect physician burnout. Almost all (96%) foresaw a role for telemedicine beyond the pandemic and would opt for a median of 50% (interquartile range 20%-66%) of visits conducted via telemedicine. Conclusions Among radiation oncologists in an academic setting, telemedicine was perceived to be highly appropriate and acceptable for most patients. Future studies should focus on identifying the 5% to 30% of patients whose care may be optimized with in-person visits, and if there is alignment with patient preferences.

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

“…Clinicians had to quickly pivot to provide substantial amounts of virtual care, resulting in the need to learn new workflows. In qualitative studies examining clinician telemedicine perspectives in the pandemic’s wake, clinicians reported challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients [ 8 , 9 ]. Although these studies set a baseline for understanding clinician barriers to telemedicine, they only explored perceptions of a relatively small number of physicians [ 8 , 10 ] or were limited to physicians from one specialty [ 9 , 11 - 13 ].…”

“…In qualitative studies examining clinician telemedicine perspectives in the pandemic’s wake, clinicians reported challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients [ 8 , 9 ]. Although these studies set a baseline for understanding clinician barriers to telemedicine, they only explored perceptions of a relatively small number of physicians [ 8 , 10 ] or were limited to physicians from one specialty [ 9 , 11 - 13 ]. Furthermore, few studies assessed clinician perspectives on effectively integrating trainees into telemedicine workflows, an important area to address to support the clinical learning environment.…”

Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience

“…2,3 Because of the pandemic, telemedicine has seen exponential growth and widespread adoption, 4 consisting of more than 90% of visits in some clinics. 5,6 Telemedicine has been used in almost every specialty, including procedural specialties. 5,[7][8][9][10][11][12][13][14][15][16][17] Further, especially since the beginning of the COVID-19 pandemic, telemedicine use has increased internationally.…”

Physician’s Perception Toward Using Telemedicine During COVID-19 Pandemic in King Abdulaziz Medical City, Riyadh, Saudi Arabia

“…Different studies delved into physicians’ perceptions toward telemedicine, one of which showed that ER physicians were the least likely to prefer telemedicine [ 14 ], while 96% of radiation oncologists foresee telemedicine to have a role beyond the pandemic [ 15 ]. Furthermore, 80% of ophthalmology patients preferred to have telemedicine as an option for first-visit evaluation [ 16 ].…”