Medical oncologists split on telehealth's clinical effectiveness

A JAMA Network study found that medical oncology professionals had conflicting opinions regarding the barriers to and benefits of video visits.
By Kat Jercich
10:25 AM
A patient speaks to a doctor on a computer

A study published this week in the Journal of the American Medical Association Network Open found that although medical oncologists recognized the convenience and access to care presented by telehealth video visits, many raised doubts about its clinical effectiveness.

The qualitative study, which took place before COVID-19 swept the country, examined 29 medical oncology health professionals' perceived benefits and drawbacks of telehealth video visits.  

"Health professionals who noted the limitations of physical examinations on telehealth cited the dependency on patient knowledge, and raised concerns that the discordance between the physical examination and patient history could cause potentially important missed findings," wrote researchers from Sidney Kimmel Medical College in the study.  

WHY IT MATTERS  

The study relied on interviews of medical oncology professionals at Thomas Jefferson University Hospital in Philadelphia conducted from October 30, 2019, to March 5, 2020.   

Researchers found that the health professionals had "opposing opinions" on the capabilities of a virtual physical examination. Some reported they could not examine a sore throat or shortness of breath via telehealth, while others stated they could assess the mouth and skin.

Respondents said telehealth would be inappropriate for a number of visit types, including first appointments, patients who are only seen every six months to a year, and patients who are symptomatic or sick.  

Still, other respondents found merits in telehealth's clinical effectiveness, with some pointing to the potential for increased frequency of patient interactions or usefulness for patients with communicable diseases.  

Respondents also had a wide variety of opinions with regard to patient experience, noting the importance of a relationship between a clinician and a patient when it comes to oncology. Several oncologists raised concerns about having discussions with patients regarding bad news through telehealth, particularly if patients had unreliable Internet access or outdated technology. 

At the same time, some respondents said telehealth could augment the patient experience and improve access to care.   

"One noted that for patients living far from large, comprehensive cancer centers, telehealth allowed them to receive treatment locally while remaining under the care of experts who specialize in their type of cancer," read the paper.  

"Furthermore, for patients with responsibilities at home, such as caring for children or elderly parents, telehealth increased their ability to see their oncologist," the researchers continued.  

Researchers note that because the interviews took place prior to the COVID-19 pandemic, perceptions of telehealth may have changed due to virtual care's rapid expansion over the last year. By April 2020, 52.4% of all visits to the cancer center took place via telehealth. 

However, they note that some limitations are continuing to emerge: "Concerns regarding the clinical efficacy of a telehealth physical examination are the most commonly reported challenges for the virtual management of cancer during the COVID-19 pandemic."  

THE LARGER TREND  

The COVID-19 pandemic undoubtedly opened new avenues for telehealth, with huge upticks in appointment numbers belying previous assumptions about patients' willingness to rely on virtual care.

It's clear, as many experts have said, that telehealth is "here to stay." But as the end of the pandemic (hopefully) eases into sight, industry leaders predict that using video visits alone will not be a dominant strategy.   

Instead, clinicians can use a wide variety of tools (such as remote patient monitoring devices and chatbots) to best integrate virtual and in-person care.  

ON THE RECORD  

"Our results emphasize the need to address oncology patients’ access to telehealth technology, especially for older populations, and the acceptability of delivering serious or bad news as telehealth continues to change the landscape of patient-health professional interactions. This is especially relevant during the COVID-19 pandemic, as many institutions worldwide have needed to create or expand telehealth programs," wrote the researchers.

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.

Want to get more stories like this one? Get daily news updates from Healthcare IT News.
Your subscription has been saved.
Something went wrong. Please try again.