Telehealth is being incorporated into many aspects of health care to bridge the gap in access for rural people. Its potential use in cancer care is gaining traction, but are patients and health professionals happy with this contemporary practice? The evidence indicates teleoncology is the way forward for rural oncology patients.
While there is a paucity of quality evidence investigating patient satisfaction with teleoncology, there are many small studies on this topic with all of them coming to similar conclusions. A systematic review by Kitamura et al found patient satisfaction to be high for use of videoconferencing technology in regional, rural and remote areas. People in these isolated areas have embraced this technology as it saves them time, money and the inconvenience of travelling to attend face to face appointments in large often unfamiliar towns or cities.
There are several novel forms of teleoncology used in different health services involving videoconferencing either with fixed computer equipment or a mobile tablet computer along with videophone and mobile phone sms services. The videoconferencing is used for clinical assessments, multidisciplinary team meetings, counselling sessions and support groups. Patient satisfaction has been high and acceptable clinical outcomes in all these studies. Additionally, research has shown there is no difference in acceptance of this technology and type of service by the indigenous people of Australia.
Provision of teleoncology is highly satisfactory to rural and remote patients due to the ability to have treatment delivered close to home without the need for travel. Research has covered six domains that impact on patient satisfaction. These are communication, costs, convenience, access to care, waiting times for care and quality and ease of use of the technology.
Patients report little difference in the effectiveness of communication between face-to-face visits and teleoncology. While health professionals feel it is important to have another health professional accompany the patient, the patient did not always believe this was necessary, presumably because they do not have a health professional supporting them when in tertiary clinics.One systematic review found that patients had a greater preference for videoconference than face-to-face consultations. Additionally Watanabe et al found wait times to patient review was decreased with the use of telehealth, further adding to patient satisfaction.
Costs are a big factor in determining satisfaction for patients. This not only includes the cost of travel and accommodation, but also income lost due to time away from work for both the patient and their carers who travel to support them. Other benefits of teleoncology include being able to remain in their own community and environment with their support networks around them. This is especially important for indigenous people.
No studies reported low patient satisfaction with teleoncology. Patients are overwhelmingly satisfied and embraced the opportunity to have care delivery closer to home. The ability to stay close to home and have family, social networks and community present at teleoncology consultations is expected to increase compliance with treatment; however this is an area needing further research.
Health professional satisfaction
Qualitative studies reveal high acceptance rates of teleoncology by health professionals. The literature identifies a myriad of uses for telehealth within the oncology field including multidisciplinary team meetings, medical oncology consultations, radiotherapy planning, colposcopic examinations, speech pathologist examination and therapy, pain management, cancer support groups and clinical psychology counselling. This highlights the acceptance by medical nursing and allied health professionals in all areas of patient care. Health professionals welcomed these new models of care for reasons including networking, support, professional up-skilling opportunities and shared care.
Two Canadian studies indicated physicians were less satisfied with the overall experience of telehealth consultations than were the patients. A study by Larcher et al states the introduction of videoconferencing technology into daily use was the greatest difficulty for physicians when first using it, however these physicians appreciated the opportunities this technology provides for rural and remote patients. This is supported by Fielding et al who reported that medical staff with little or no previous experience with telehealth are less receptive to this form of care delivery. This stresses the importance of appropriate education and service planning for teleoncology prior to the implementation of this form of care. Acceptance and uptake of teleoncology models by health professionals can be enhanced through training and education in telehealth models of care. One example of a web based training tool is Three steps to telehealth by the University of New South Wales, Australia.
Studies by Wilbur et al and Burns et al found the use of speciality equipment enabled them to provide complex physical examination that was equal to that of face-to-face meetings. These needed to be easy to use, with an adequate quality of visual and auditory systems.A study by Weinerman et al found no difference in satisfaction for face-to-face versus teleoncology with the exception of one oncologist who felt teleoncology was not as successful as face-to-face due to frustration with the technology.
A study be Sezeur et al found that satisfaction with teleoncology was high. There was no difference in the clinical relationship between the specialist and the patient, or the quality of the message delivered and received using teleoncology compared to face-to-face consultation. Additionally, a huge saving in cost was gained from patients or specialists not needing to travel to consultations. In Hazin & Qaddoumi’s 2010 review of teleoncology initiatives they found that while it is not the remedy for all things cancer related, it is an effective tool to bridge the gaps in access to services for rural and remote people.
The greatest concern for health professionals appears to be the ability to examine patients. In some areas this has been overcome through the presence of the local general practitioner, medical officer, nurse practitioner or senior registered nurse to support the specialist with this aspect of care.
The benefits of teleoncology involving a health professional at the primary sites includes increased knowledge of cancer, its treatments and side-effect management; improved networking and comfort with liaising with the tertiary team and upskilling for those who see few cases in the rural and remote sites. Haozous et al found perceived competence in pain management for patients increased significantly for those health professionals who attended case conferences by telehealth compared to those who did not. This supports the educational benefits of participation in teleoncology.
The greatest benefit of teleoncology is the improved two-way communication between the tertiary and primary health care providers and increased patient trust of communication within their healthcare team.
Data from Weinnerman et al’s trial showed a tenfold increase in the use of teleoncology for rural patients over five or more years, indicating the growing acceptance of this form of patient management among both patients and specialists.
|Many small studies report high levels of patient satisfaction by both Indigenous and non Indigenous patients and families with teleoncology models, in relation to benefits including reduction in travel to larger centres, ability to establish rapport and relationship with specialists, ability to receive medication safely and overall quality of the services they receive closer to home.||IV||, , |
|Teleoncology models of care are acceptable to patients from rural and remote areas including Aboriginal and Torres Strait Islanders.||C|
In line with contemporary research teleoncology and telehealth must be considered as an important adjunct when developing new oncology models of care to deliver care closer to home in rural and remote Australia.
Appropriate resources, both human and material should be allocated for the implementation of this form of care provision. Additionally, adequate training and support on the use of this technology must be provided prior to commencement of a teleoncology service.
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