Telemedicine Utilization in the Ambulatory Palliative Care Setting: Are There Disparities in Access for Patients with Cancer?

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.