Teleneuropsychology practice survey during COVID-19 within the United States

Abstract

Objective: Identify factors influencing service delivery changes during COVID-19 and examine barriers and provider satisfaction with teleneuropsychology (teleNP). Method: Licensed clinical neuropsychologists within the United States recruited via neuropsychology-specific listservs (July-August 2020) to complete an online survey. Results: A total of 261 individuals completed the survey. Most (76%) reported delivering in-person testing in some capacity at the time of our survey. Relatively more private practitioners identified concerns with privacy/confidentiality (45.2% vs. 17.9%; v 2 (2) ¼ 6.99, p < 0.05), legal issues (47.6% vs. 17.9%; v 2 (2) ¼ 8.06, p < 0.05), and an undesirable precedent for legal/forensic cases (59.5% vs. 15.4%; v 2 (2) ¼ 17.54, p < 0.001) compared to hospital or other medical (non-VA) practitioners. Multiple resources informed teleNP protocols, such as organization guidelines (87.6%), literature review (75.9%), webinars (72.4%), and consultation (68%). Several factors influenced test selection, including availability of normative data (70.1%), test familiarity (66.4%), administration time (63.5%), and evidence base (60.6%). Reported barriers to continuing teleNP after COVID-19 included need for improved teleNP norms (85.9%), domain coverage (84.7%), improved patient access to technology (74.1%) and further validation studies (84.1%). Conclusion: TeleNP may not be feasible in all settings and/or referrals. Respondents employed multiple resources in aggregating teleNP protocols and considered several factors when selecting tests. Results highlight the complex and varied decision-making processes utilized by respondents to adapt to service delivery changes. Considering the many benefits of teleNP, future research addressing some of the potentially modifiable factors (e.g., technology access, attitudes regarding teleNP) and significant development needs for teleNP itself (i.e., improved teleNP norms, further validation studies, etc.) is warranted.

Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults

“…Zoom®, Doxy.Me®, and MyChart® were the platforms used by the majority of respondents to conduct remote cognitive assessments, similar to what was found by Rochette et al (2021) in their survey study. The use of certain technologies for TeleNP was largely driven by organizational-related mandates and/or due to the HIPAA-compliant features of these technologies (see Table 2 ).…”

“…We also sought information on the common strategies that TeleNP users employed to navigate the challenges associated with TeleNP use, and based on the data we have proposed some practical solutions to address specific challenges. Although a recent study by Rochette et al (2021) used a similar survey design, our study is unique because we included information not reported elsewhere, such as the inclusion of information related to the use of TeleNP for clinical versus research purposes and the reasons TeleNP users were using or switched between TeleNP technologies. We also elicited the perspectives of non-neuropsychologists in the USA (e.g., graduate students, research assistants, psychometricians) who use/used TeleNP.…”

“…Comparatively less research has been conducted in home-to-home or clinic-to-home settings ( Abdolahi et al, 2016 ; Park et al, 2017 ; Stillerova et al, 2016 ), with a handful of new studies having been published recently during the COVID-19 pandemic ( Fox-Fuller et al, 2021 ; Parks et al, 2021 ; Seghezzo et al, 2021 ). Such a discrepancy in the actual practice of TeleNP in settings different from how previous TeleNP research has been conducted may have heightened the concerns about the reliability and validity of TeleNP as a means for remote cognitive assessment ( Rochette et al, 2021 ; Scott et al, 2021 ).…”

“…Early surveys of neuropsychologists conducted immediately after the start of the COVID-19 pandemic-related lockdowns found there was initially relatively low initial uptake of TeleNP for the purpose of administering cognitive assessments, with many respondents solely engaging in remote clinical interviews and feedback ( Chapman, Ponsford, et al, 2020b ; Hammers et al, 2020 ; Marra, Hoelzle, et al, 2020b ). In the USA by July 2020, however, one study found that nearly two-third of the surveyed U.S. licensed neuropsychologists began using TeleNP for the purposes of remote cognitive assessment ( Rochette et al, 2021 ). Initially slow uptake of TeleNP for the purposes of remote cognitive assessment was due to several concerns, including: deviation from in-person delivery of neuropsychological services; limited information on preferred measures to use for a cognitive assessment, including concerns about reliability and validity of measures administered remotely; restricted funding or institutional support for TeleNP practice; and inadequate knowledge or familiarly with telehealth technologies on the part of the examiner and/or examinee ( Chapman, Ponsford, et al, 2020b ; Hammers et al, 2020 ; Marra, Hoelzle, et al, 2020b ).…”

“…For example, the Inter Organizational Practice Committee (IOPC) recommendations ( Bilder et al, 2020 ; Postal et al, 2021 ), as well as those advanced by other groups—such as the Neuropsychology Service within the Department of Neurology at the Emory University Brain Health Center ( Hewitt et al, 2020 ; Hewitt & Loring, 2020 ) and the Center for Cognitive Neuroscience and Aging at the University of Miami in Miami, Florida ( Kitaigorodsky et al, 2021 )—have responded to this need by focusing largely on the clinical use of TeleNP. However, the perspectives of the broader community of clinicians and researchers conducting cognitive assessments using TeleNP has not been well characterized to date, with only one recently published survey of licensed U.S. neuropsychologists by Rochette et al (2021 ), to our knowledge, more fully exploring the first-hand experiences of TeleNP users. By examining the experiences of individuals using TeleNP for remote cognitive assessment—including the perspectives of nonlicensed individuals conducting remote cognitive assessments (e.g., graduate students, postdoctoral fellows, psychometricians, research assistants, and allied health professionals)—more focused guidelines can be developed to address the specific challenges that are being encountered with remote cognitive assessment.…”