Elective Telemedicine: Are Older Women Receiving Postprimary Treatment of Early Breast Cancer Interested?

ABSTRACT

Background: Explosive growth in the use of telemedicine occurred during the coronavirus disease 2019 (COVID-19) pandemic. To benefit from telemedicine, patients must have the capacity to engage with technology, for which inexperience and access may pose barriers particularly in older adults. Telemedicine also has the potential to lessen healthcare burden in this population due to frequent appointments, physical and cognitive disabilities, and reliance on caretakers. This study aimed to better understand the perspectives of older women with non-metastatic breast cancer on telemedicine, in regards to visit convenience, completeness, and interpersonal satisfaction. Methods: In this qualitative study, semi-structured interviews were conducted in a convenience sample of women age 65+, postprimary treatment for Stage I-III breast cancer, who received in-person outpatient care at NCCH (NC Cancer Hospital) before transitioning to telemedicine after March 2020. Patients were interviewed about their perceptions of telemedicine (telephone, video) as compared to in-person visits. Audio files of interviews were transcribed and reviewed to identify themes established a priori in the interview protocol. Results: 15 patients (telephone=5, video=10) were consented and interviewed (July-October 2021), mean age=74. 87% (13/15 participants) reported that they preferred a hybrid care model that included telemedicine care over in-person care alone. COVID-19, physical disability, and transportation burden were associated with telemedicine preference. Comfort with familiar patient-provider interaction and lack of physical exam were associated with in-person appointment preference. In-person appointment was favored early in the postprimary treatment phase;telemedicine was more acceptable when relationships were well-established, and patients had lower illness anxiety. All participants who had appointments via video preferred it over telephone, whereas some participants who had telephone visits wanted to use video but faced technological challenges in its use. Conclusions: Patient-clinician conversations and clinic protocols guiding decisions about the use of telemedicine should take into account newness of diagnosis, patient comfort and familiarity with the care team, travel burden, disability, and an explanation as to whether the physical exam is or is not essential.