Virtual cancer care in a tertiary care academic centre in Ireland during the COVID-19 pandemic - An analysis of physician and patient opinion

ABSTRACT

In an effort to limit physical contact during the COVID-19 pandemic, there has been rapid implementation of virtual cancer care clinics using messaging, audio, and video communication. This model has advantages, particularly in convenience for patients who do not have to travel to a distant centre for specialist care, but has the potential to limit communication and also omits physical examination. The aim of this survey study was to assess whether patients attending the oncology unit at a tertiary care academic cancer centre were satisfied with the virtual clinic model and explore challenges in the delivery of virtual care. We also surveyed medical oncology trainees and consultant oncologists in the centre on the use of virtual care. Methods: All patients attending St Vincent's University Hospital Oncology, Dublin, Ireland, who had received a virtual oncology clinic appointment were invited by text message to participate in a survey study analysing attitudes towards virtual oncology clinics. Medical oncology trainees and consultants working were also invited to give their opinions. Results: Between April and October 2020, 207 patients (of 600 invited) who had at least one virtual clinic consultation responded to the survey. 95% had their consultation via telephone, and 5% by email. 80% reported satisfaction with the experience. 85% received timely notice of their appointment, but 50% of patients did not receive a telephone call at the scheduled time. 80% of patients thought they had enough time with the doctor. Some patients who were travelling from outside Dublin found virtual clinics more convenient. 50% of patients want to continue virtual consultations post Covid-19;the main criticism was that patients want to receive the call at the appointed time. 14 medical oncology trainees (of 18 invited)and 6 consultants (of 8 invited) responded to the survey. 92% of trainees and 100% of consultants believed virtual care is inferior to face to face care. 85% of junior doctors and 100% of consultants surveyed found clinical assessment more difficult via virtual consultation, but 76% of trainees and 100% of consultants found virtual clinics more time efficient. 62% of trainees reported face to face clinics as better for education from consultants. 80% of consultants believed the education of trainees was inferior in virtual clinics. 62% of trainees and 100% of consultants would like to continue virtual care in some form post Covid -19. Conclusions: Irish patients attending a tertiary academic cancer centre were mostly satisfied with the telephone consultations they had with their oncology team. Satisfaction rates were lower among the doctors than patients, reflecting doctors' difficulties in clinical assessment and teaching opportunities using virtual care. This survey highlights the need for more advanced technical platforms (including video calling and real time messaging) to provide excellent virtual care, as well as the development of new strategies for medical education through virtual clinics.