ABSTRACT
Purpose: The objective of this study was to test for patient characteristics associated with virtual versus office visits among radiation oncology patients. Methods and Materials: Using the electronic health record, we extracted encounter data and corresponding patient information for the 6 months before and 6 months of COVID-19-enabled virtual visits (October 1, 2019, to March 22, 2020 vs March 23, 2020, to September 1, 2020) at a National Cancer Institute-Designated Cancer Center. Encounters during COVID-19 were categorized as in-person or virtual visits. We compared patient demographic variables including race, age, sex, marital status, preferred language, insurance status, and tumor type during the pre-COVID-19 period as a baseline versus during the COVID-19 period. Multivariable analyses examined associations between these variables and virtual visit use. Results: We analyzed 4974 total encounters (2287 before COVID-19 and 2687 during COVID-19) for 3960 unique patients. All (100%) pre-COVID-19 encounters were in-person. During COVID-19, 21% of encounters were via virtual visits. There were no differences identified in pre- versus during-COVID-19 patient characteristics. However, we found significant differences in patient characteristics for in-person versus virtual encounters during COVID-19. On multivariable analysis, virtual visit use was less common among patients who were Black versus White (odds ratio [OR], 0.75; 95% CI, 0.57-0.99; P = .044) and not married versus married (OR, 0.76; 95% CI, 0.59-0.98; P = .037). Patients with head and neck (OR, 0.63; 95% CI, 0.41-0.97; P = .034), breast (OR, 0.36; 95% CI, 0.21-0.62; P ≤ .001), gastrointestinal/abdominal (OR, 0.31; 95% CI, 0.15-0.63; P = .001), or hematologic malignancy (OR, 0.20; 95% CI, 0.04-0.95; P = .043) diagnoses were less likely to be scheduled for virtual visits relative to patients with genitourinary malignancy. No Spanish-speaking patients engaged in a virtual visit. We did not identify differences in the insurance status or sex of patients scheduled for virtual visits. Conclusions: We found significant differences in virtual visit use by patient sociodemographic and clinical characteristics. Further investigation into implications of differential virtual visit use including social and structural determinants and subsequent clinical outcomes is indicated.
ABSTRACT
During the COVID-19 pandemic, many oncology practices began offering virtual visits via video and/or telephone. How such visits are perceived by Black patients, who have historically faced access barriers and poorer cancer outcomes, is not known. We elicited Black patients' perceptions of and experiences with oncology virtual visits. We conducted in-depth, semi-structured telephone interviews with Black adults receiving oncology care for head and neck cancer, prostate cancer, and multiple myeloma between 6/1/19 - 3/20/21 from two US-based academic health systems. The interview guide elicited virtual visit perceptions and experiences within predefined themes (e.g., ease of use, usefulness, communication quality, appropriateness). Interviews were audio-recorded, transcribed, and coded for a priori themes and new ones identified during data immersion. Two trained research assistants coded transcripts, using Atlas.ti for data management. Forty-nine adults completed an interview between 9/2021 and 2/2022 (n=16 head and neck, n=16 prostate, and n=17 multiple myeloma);mean age 63 years (range: 39-75), 53% male, and 77% ever having a virtual visit. Participants indicated communication with their doctor and privacy was comparable between in-person and virtual visits but expressed feeling less human connectedness during virtual visits. They cited convenience advantages (e.g., being home, flexibility when physicians run late, and reduced travel barriers);however, they also reported preferring in-person visits, due to wanting doctors to conduct physical examinations or needing in-person testing. Participants described wanting a choice regarding visit type and valued it when physicians articulated the option to conduct an in-person visit (i.e., patient-centeredness in scheduling). To overcome technical barriers to virtual visit attendance, patients received assistance from adult children, physicians, and other support. We identified barriers to and facilitators of virtual visit use among Black patients receiving cancer care. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)