ABSTRACT
Background: Synchronous video visits (“telehealth”) were rapidly adopted to facilitate provision of cancer care during the COVID-19 pandemic, with little time to comprehensively assess patient and provider needs. Attitudes toward telehealth use during active treatment (vs. survivorship care) were largely unknown, as were perceptions of, experiences with, and needed support for telehealth use among older adults with cancer. Older adults in particular may face increased vulnerability to inequities in access to care due to limited digital literacy. Methods: We conducted surveys and semi-structured interviews with providers, staff, and older patients (age ≥60) from a comprehensive cancer center. Data collection occurred between Dec 2020 - Nov 2021. Results: We completed a total of 106 provider/staff surveys, 128 patient surveys, 20 provider/staff interviews, and 15 patient interviews. A majority of surveyed providers/staff felt that telehealth should “definitely be offered” during treatment-phase encounters (55.9% treatment follow-up;69.1% results communication;70.2% discussing treatment side effects). Similarly, most patients indicated they would be willing to have video visits with a member of their care team for: discussing treatment side-effects (73.5%), results communication (69.6%), and treatment follow-up (65.7%). Patients reported experiencing challenges with joining video visits (29%) and understanding the telehealth process (28%). Similarly, less than a third (30.8%) of providers/ staff agreed or strongly agreed that the institution did a good job of preparing patients for their first telehealth encounter. Patients felt the institution should do more to communicate the advantages of telehealth to older adults in handouts and videos, which included: engaging multiple family members in critical appointments (e.g., treatment decisions, end-of-life), seeing their doctor when they were too sick to travel, and reducing potential exposure to infectious disease at the clinic. Participants suggested several strategies to assist patients with limited digital literacy: offering video tutorials of the connection process, creating “fake appointments” to practice online connections, and hiring a digital navigator to assist with technical difficulties and setup of the online portal. Despite challenges, a majority of surveyed patients (65.7%) and providers/staff (76.9%) intend to continue using telehealth after the COVID-19 pandemic passes. Conclusions: Use of telehealth for cancer care was received positively by older patients and providers/staff. Taking targeted steps to enhance implementation could reduce barriers to care, including among older adults and other populations with limited digital literacy, thereby promoting greater equity of access to telehealth benefits beyond the pandemic.
ABSTRACT
Background: The COVID-19 pandemic created an urgent need for timely and accurate public health information. This is especially true for those with cancer because they face higher morbidity and mortality from COVID-19. At the same time, the disproportionate impact of the pandemic on Latinx populations underscores the need for information to reach Spanishspeakers. Given the large proportion of Spanish-speakers in the U.S., healthcare institutions have a professional and moral obligation to meet this critical need. Methods: We conducted a multi-modal, mixed method document review study to evaluate the equity of online information about COVID and cancer available to English- and Spanish-speakers from seven north Texas healthcare institutions. We sampled 50 websites (33 English, 17 Spanish) over a one-week period in May 2020. Websites included 27 healthcare institutions and 23 external organizations (e.g. CDC). Thematic content was analyzed using a coding conversion process;literacy level was measured using Readability software;accessibility was measured using the Patient Education and Materials Assessment Tool (PEMAT);and video and diversity content were defined and counted. Results: Content on Spanish websites was sub-optimal compared to English. We observed significant differences in thematic content, poor linkage to external Spanish content, and errors in translation. Whether differences were intentional was unclear. Across all sites, content specifically about COVID and cancer was more prevalent in English than Spanish (58% vs. 43%). Three institutions' websites contained no information about COVID specifically for cancer patients, and three institutions included only a banner link to COVID updates or information from their main oncology page. Only one institution's website included comprehensive COVID-related information specifically for cancer patients, such as postponing treatment, oral cancer treatments, and extra assurances taken for protection during in-person care;however, this website was available in English only. Spanish websites scored on average at a lower literacy level than English (11 vs. 13 grade). Using the PEMAT, healthcare institutions' average accessibility of Spanish pages (n = 7) was slightly lower than that of English pages (n = 19) (77% vs. 81%, respectively), due mostly to discrepancies in English-only videos and visual aids;conversely, among external organizations' websites, the average accessibility score of Spanish pages (n = 10) was higher than that of English pages (n = 13) (86% vs. 83%, respectively). Conclusions: In one region, Spanish-speakers lack equitable access to information about COVID-19 and cancer compared with English-speakers, leaving an already vulnerable patient population at greater risk for poor health outcomes. We offer recommendations for enhancing equity of access to information.