ABSTRACT
To examine demographic, socioeconomic, and regional differences between in-person and telehealth contraception visits and telehealth visit quality in the US during the COVID-19 pandemic. In July 2020 and January 2021, we surveyed reproductive-aged women about experiences seeking contraception. We created a COVID-19 hardship score assessing pandemic-related job, income, and housing loss and a telehealth quality score assessing telehealth visit convenience, communication, and privacy. We used chi-square tests and multivariable logistic regression to examine relationships between baseline variables and in-person vs. telehealth visits and telehealth quality scores. Among 2,028 respondents who answered questions about contraception visits, 1,490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, respondents identifying as Hispanic/Latina and mixed race/other (adjusted OR (aOR), 0.59 and 0.36, respectively), from the South, Midwest, or Northeast (aOR, 0.63, 0.64, 0.52, respectively), without insurance (aOR 0.63), and with greater COVID-19 hardship (aOR 0.52) had significantly lower odds of attending any visit (all p<0.05). Among respondents with any visit for contraception, respondents from the Midwest and South had significantly lower odds of having a telehealth versus in-person visit (aOR 0.63 and 0.54 respectively, p<0.01). Hispanic/Latina respondents and those in the Northeast had significantly lower odds of reporting high telehealth quality (≥75th percentile) (aOR 0.53 and 0.65, respectively, p<0.05). Disparities in telehealth usage for contraception among people identifying as Hispanic/Latina and people in the South and Midwest, and in telehealth quality among Hispanic/Latina people. Further research should focus on patients' desires around telehealth and increasing access to telehealthcare. [ FROM AUTHOR]
ABSTRACT
Background: Intensive childhood cancer treatment produces suffering. In addition to physical symptoms, children miss out on life events and experience social isolation. Professionals' attitudes and actions shape children's lives during cancer treatment. Primary palliative care consists of quality of life (QOL)-promoting care enacted by professionals who are not acting within the context of specialty palliative care teams. Despite the rapid growth of specialty pediatric palliative care teams, most children receiving cancer treatment do not receive specialty pediatric palliative care. Yet how professionals conceptualize and enact their primary palliative care roles in the current era remains poorly understood. Objectives: We sought to understand: (1) professionals' role expectations for themselves and others to relieve suffering and promote joy, meaning, and accomplishment for children in their care;(2) perceived barriers and facilitators to promoting QOL for children in their care;(3) how team dynamics promote or impede QOL for children in their care. Design/Method: We utilized theoretical sampling and conducted semi-structured interviews of professionals working in a pediatric oncology center. Professionals were invited to participate via email and interviews were conducted face-to-face, by telephone, or via secure video conference by non-clinical members of the research team. Through constant comparative analysis, early interviews informed subsequent data collection. Thematic analysis incorporated the following data sources: audio-recordings, interview transcripts, debriefing discussions with interviewers, and memos. Results: Fifteen interviews were conducted April-September 2021 with oncologists (MDs/NPs), nurses, social workers, child life specialists, chaplains, and psychologists. Communication to share information and build on each other's ideas emerged as a central theme. Issues of presence and parity emerged: physical distancing and restrictive visitation policies due to the COVID-19 pandemic were impediments to promoting QOL. Some respondents perceived less patient isolation and exclusion when normal life seemed universally out of reach in the early months of the pandemic. Changes in working patterns induced by COVID-19 were seen as threats to communication, and by extension, to patients' QOL. Within-professions team membership was strengthened by weathering changes wrought be COVID-19. By contrast, efforts to ensure communication across professions were perceived to be asymmetric, leaving some clinicians feeling devalued and at times heightening tensions between professions. Conclusion: Communication, presence, and parity emerged as preliminary facilitators and barriers to working interprofessionally to promote QOL, particularly in the context of the COVID-19 pandemic. Understanding professionals' attitudes and actions around QOL for children with cancer will inform future interventions to enhance interprofessional primary palliative care.