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1.
J Am Med Inform Assoc ; 2022 May 20.
Article in English | MEDLINE | ID: covidwho-1860867

ABSTRACT

OBJECTIVE: To describe adaptations necessary for effective use of direct-to-consumer (DTC) cameras in an inpatient setting, from the perspective of health care workers. METHODS: Our qualitative study included semi-structured interviews and focus groups with clinicians, information technology (IT) personnel, and health system leaders affiliated with the Mount Sinai Health System. All participants either worked in a COVID-19 unit with DTC cameras or participated in the camera implementation. Three researchers coded the transcripts independently and met weekly to discuss and resolve discrepancies. Abiding by inductive thematic analysis, coders revised the codebook until they reached saturation. All transcripts were coded in Dedoose using the final codebook. RESULTS: Frontline clinical staff, IT personnel, and health system leaders (N = 39) participated in individual interviews and focus groups in November 2020-April 2021. Our analysis identified five areas for effective DTC camera use: technology, patient monitoring, workflows, interpersonal relationships, and infrastructure. Participants described adaptations created to optimize camera use and opportunities for improvement necessary for sustained use. NOn-COVID-19 patients tended to decline participation. DISCUSSION: Deploying DTC cameras on inpatient units required adaptations in many routine processes. Addressing consent, two-way communication issues, patient privacy, and messaging about video monitoring could help facilitate a nimble rollout. Implementation and dissemination of inpatient video monitoring using DTC cameras requires input from patients and frontline staff. CONCLUSIONS: Given the resources and time it takes to implement a usable camera solution, other health systems might benefit from creating task forces to investigate their use before the next crisis.

2.
Journal of Pain and Symptom Management ; 63(5):862, 2022.
Article in English | ScienceDirect | ID: covidwho-1783541

ABSTRACT

Outcomes 1. Describe disparities in telemedicine utilization for patients with cancer in the ambulatory palliative care setting 2. Identify strategies to address disparities in telemedicine access for patients with cancer in the ambulatory palliative care setting Original Research Background Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities. Research Objectives Examine characteristics associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting. Methods We collected data on patients seen in the supportive oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics. Results A total of 491 patients and 1,783 visits were identified, including 1,061 (60%) in-person visits and 722 (40%) telemedicine visits. Spanish-speaking patients (OR 0.32, 95% CI 0.17-0.61), those without insurance (OR 0.29, 95% CI 0.16-0.53), and those without an activated patient portal (inactivated: OR 0.45, 95% CI 0.26-0.80;pending activation: OR 0.29, 95% CI 0.18-0.47) were less likely to use telemedicine. In a comparison of video to audio-only visits in a secondary analysis, married patients were more likely to engage in video visits (OR 1.89, 95% CI 1.05-3.39). Conclusion Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are Spanish-speaking, uninsured, or unmarried or do not have an activated patient portal. These findings suggest that the recent shift to telemedicine as a substitute for in-person visits may exacerbate existing disparities in access to disease-directed therapy, symptom management, and serious illness communication. Implications for Research, Policy, or Practice In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions.

3.
J Pain Symptom Manage ; 63(3): 423-429, 2022 03.
Article in English | MEDLINE | ID: covidwho-1458612

ABSTRACT

CONTEXT: Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities. OBJECTIVES: To examine factors associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting. METHODS: We collected data on patients seen in Supportive Oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics. RESULTS: A total of 491 patients and 1783 visits were identified, including 1061 (60%) in-person visits and 722 (40%) telemedicine visits. Female patients were significantly more likely to utilize telemedicine than male patients (OR 1.46; 95% CI 1.11-1.90). Spanish-speaking patients (OR 0.32, 95% CI 0.17-0.61), those without insurance (OR 0.28, 95% CI 0.15-0.52), and those without an activated patient portal (Inactivated: OR 0.46, 95% CI 0.26-0.82; Pending Activation: OR 0.29, 95% CI 0.18-0.48) were less likely to utilize telemedicine. CONCLUSION: Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are male, Spanish-speaking, uninsured, or do not have an activated patient portal. In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions.


Subject(s)
COVID-19 , Telemedicine , Ambulatory Care , Female , Humans , Male , Palliative Care , Pandemics , SARS-CoV-2
5.
J Pain Symptom Manage ; 62(3): e206-e212, 2021 09.
Article in English | MEDLINE | ID: covidwho-1101394

ABSTRACT

CONTEXT: High quality communication is essential to older adults' medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (four days, 10 hours total). OBJECTIVES: Our study evaluated the change in participants' self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course. METHODS: Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed five-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication. RESULTS: Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5-point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (P < 0.01) improvements in mean self-reported preparedness across all surveyed communication skills. CONCLUSION: We show that a virtual communication skills training is feasible and effective. Our findings suggest that the innovative virtual Geritalk course has the potential to increase access to communication skills training, improve serious illness communication skills, and in improve the quality of care received by older adults with serious illness.


Subject(s)
COVID-19 , Quality of Life , Aged , Communication , Humans , Pandemics , SARS-CoV-2
6.
J Clin Oncol ; 39(2): 155-169, 2021 01 10.
Article in English | MEDLINE | ID: covidwho-1013168

ABSTRACT

This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.


Subject(s)
Biomedical Research , COVID-19/therapy , Medical Oncology , Neoplasms/therapy , SARS-CoV-2 , Clinical Trials as Topic , Delivery of Health Care , Humans , Research Design , Societies, Medical
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