Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario.
Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario; Faculty of Medicine, University of Toronto, Toronto, Ontario.
Arch Phys Med Rehabil. 2021 Jul;102(7):1283-1293. doi: 10.1016/j.apmr.2021.02.002. Epub 2021 Feb 19.
OBJECTIVE: To describe the adaptations made to implement virtual cancer rehabilitation at the onset of the coronavirus disease 2019 pandemic, as well as understand the experiences of patients and providers adapting to virtual care. DESIGN: Multimethod study. SETTING: Cancer center. PARTICIPANTS: A total of 1968 virtual patient visits were completed during the study period. Adult survivors of cancer (n=12) and oncology health care providers (n=12) participated in semi-structured interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Framework-driven categorization of program modifications, qualitative interviews with patients and providers, and a comparison of process outcomes with the previous 90 days of in-person care via referrals, completed visits and attendance, method of delivery, weekly capacities, and wait times. RESULTS: The majority of program visits could be adapted to virtual delivery, with format, setting, and content modifications. Virtual care demonstrated an increase or maintenance in the number of completed visits by appointment type compared with in-person care, with attendance ranging from 80%-93%. For most appointment types, capacities increased, whereas wait times decreased slightly. Overall, 168 patients (11% of all assessments and follow-ups) assessed virtually were identified by providers as requiring an in-person appointment because of reassessment of musculoskeletal and/or neurologic impairment (n=109, 65%) and lymphedema (n=59, 35%). The interviews (n=24) revealed that virtual care was an acceptable alternative in some circumstances, with the ability to (1) increase access to care; (2) provide a sense of reassurance during a time of isolation; and (3) provide confidence in learning skills to self-manage impairments. CONCLUSIONS: Many appointments can be successfully adapted to virtual formats to deliver cancer rehabilitation programming. Based on our findings, we provide practical recommendations that can be implemented by providers and programs to facilitate the adoption and delivery of virtual care.
目的：描述在 2019 年冠状病毒病大流行开始时实施虚拟癌症康复所做的调整，以及了解患者和提供者适应虚拟护理的经验。
设计：多方法研究。
地点：癌症中心。
参与者：在研究期间共完成了 1968 次虚拟患者就诊。癌症幸存者（n=12）和肿瘤保健提供者（n=12）参加了半结构性访谈。
干预措施：不适用。
主要观察指标：方案修改的框架驱动分类、患者和提供者的定性访谈，以及通过转介、完成就诊和就诊率、交付方式、每周容量和等待时间与前 90 天的面对面护理进行过程结果比较。
结果：大多数方案就诊都可以适应虚拟交付，格式、环境和内容都可以进行调整。与面对面护理相比，虚拟护理通过预约类型显示就诊次数增加或保持不变，就诊率在 80%-93%之间。对于大多数预约类型，容量增加，而等待时间略有减少。总体而言，168 名患者（所有评估和随访的 11%）因重新评估肌肉骨骼和/或神经系统损伤（n=109，65%）和淋巴水肿（n=59，35%）而被提供者确定需要进行面对面就诊，通过虚拟方式就诊。访谈（n=24）显示，在某些情况下，虚拟护理是一种可接受的替代方式，具有（1）增加获得护理的机会；（2）在隔离期间提供安慰感；（3）对学习自我管理损伤的技能有信心。
结论：许多就诊可以成功地适应虚拟格式，以提供癌症康复方案。根据我们的研究结果，我们提供了实用的建议，提供者和方案可以实施这些建议，以促进虚拟护理的采用和交付。
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