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Introduction: The use of telemedicine in surgical care quickly increased due to the COVID-19 pandemic. However, uptake among surgical specialties has not been consistent. We aimed to characterize surgical provider perceptions of barriers and facilitators to telemedicine use. Method(s): Surgeons and nurses within the gastrointestinal surgery division at a high-volume, tertiary care academic center were contacted for participation in this study. Individual semi-structured interviews explored barriers and facilitators to telemedicine use. Qualitative analysis was conducted by multiple coders using NVivo12 software. Result(s): Six surgeons and three nurses participated in this study. Among the 9 participants, 44% identified as female and 33% were over age 50. Three themes were identified as facilitators to provider utilization of telemedicine: increased accessibility for rural patients due to decreased travel time and cost, enhanced provider productivity from reduced transition time between visits, and the ability of video telemedicine to facilitate non-verbal communication and visual examination. Three themes were identified as barriers to provider utilization of telemedicine: unreliable broadband connection, negative impacts on workflow due to scheduling challenges and insufficient IT support, and the inability to conduct a physical exam and immediately manage certain complications. Conclusion(s): As telemedicine becomes highly integrated into routine care, best practice guidelines to surgeon-patient telemedicine encounters should be established. This will improve virtual communication and consistency across providers, as well as provider satisfaction with telemedicine. Future interventions should address concerns with workflow logistics and technical support by developing comprehensive training and troubleshooting strategies for healthcare providers.
RESUMEN
Purpose/Background: Telemedicine use has increased during the COVID-19 pandemic, but uptake among patient populations has not been equitable. Lack of access to technology or broadband connection contributes to the digital divide, but additional factors at the provider-level may contribute. Hypothesis/Aim: We aimed to identify barriers and facilitators to colorectal patient use of telemedicine with a focus on trust and the patient-provider relationship. Methods/Interventions: Patients 18 years and older who were seen via telemedicine at a colorectal surgery clinic at a high-volume, tertiary care academic center were contacted for participation in this study. Patient demographics including age at surgery, race, sex, and diagnosis were recorded. Patient health literacy was evaluated using the BRIEF Health Literacy Screening Tool. The Wake Forest Physician Trust Scale (WFPTS) was used to measure patient trust in providers. Individual semi-structured interviews based on developed guides explored barriers and facilitators to telemedicine use. Interviews were recorded and transcribed using Landmark. Qualitative analysis was conducted using NVivo12 software. Each coder reviewed the transcript independently, convening after initial review for discussion. Final themes were analyzed by disease process. Results/Outcome(s): Among 29 participants, 52% identified as female, 67% White, 30% Black, and 4% Latino, which closely mirrors the racial demographics of the study region. 33.3% of patients had limited health literacy with a mean BRIEF score of 17.6 out of 20 (SD 3.33). The WFPTS scale ranged from 44 to 50, with a mean of 48.5 (SD 2.1) in both IBD and cancer patients. Three major themes were identified as important with respect to trust during telemedicine visits: trust in providers, trust in the institution, and trust in the surgical process. Of these, provider-level trust appeared to most influence patient trust in telemedicine. All participants noted that institution reputation and surgeon confidence affected trust in telemedicine. Among cancer participants, the impact of transparency and established expectations emerged as important themes. Among IBD patients, the duration of the patient encounter and time spent answering questions appeared most relevant. Limitations: The generalizability of our results may be limited because all patients were seen via telemedicine at a single institution. Conclusions/Discussion: Provider-level trust may have an increased role in colorectal surgery patients. To improve patient trust and telemedicine engagement in the colorectal patient population, particularly for those affected by chronic disease, providers and healthcare systems should build and integrate interventions that enhance communication and interpersonal skills.