School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Support Care Cancer. 2022 Dec;30(12):9859-9868. doi: 10.1007/s00520-022-07437-0. Epub 2022 Nov 15.
Telemedicine has the potential to lessen healthcare burden of older patients due to frequent appointments, physical disabilities, and reliance on caretakers. To benefit from telemedicine, patients must have the capacity and willingness to engage with technology. This study aimed to better understand the telemedicine experiences of older women with non-metastatic breast cancer regarding visit convenience, completeness, and interpersonal satisfaction.
Semi-structured interviews were conducted in a convenience sample of women age 65+, post-primary treatment for stage I-III breast cancer, who had received in-person outpatient care at a cancer center in urban North Carolina before a telemedicine appointment occurring 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 analyzed for themes and subthemes established a priori in the interview protocol.
Fifteen patients (telephone = 5, video = 10) were consented and interviewed July-October 2021, mean age 74. Thirteen participants reported they preferred a hybrid care model that included telemedicine care over in-person care alone. COVID-19, physical disability, and transportation burden were the most common factors for telemedicine preference. Comfort with familiar face-to-face interactions and having a physical exam were common factors for in-person appointment preference. In-person appointment was favored early in the post-primary treatment phase; telemedicine was more acceptable when relationships were well-established and patients were farther out from diagnosis.
Patient-provider discussions about appointment modality should take into account newness of diagnosis, patient familiarity with the care team, travel burden, and necessity of physical exam.
由于频繁的预约、身体残疾以及对照顾者的依赖，远程医疗有可能减轻老年患者的医疗负担。为了从远程医疗中受益，患者必须有能力和意愿使用技术。本研究旨在更好地了解患有非转移性乳腺癌的老年女性患者对远程医疗的体验，包括就诊的便利性、完整性和人际满意度。
采用便利抽样法，选取北卡罗来纳州城市癌症中心接受过门诊治疗的 15 名年龄在 65 岁以上、接受过 I-III 期乳腺癌初级治疗、在 2020 年 3 月后接受远程医疗预约的女性患者进行半结构式访谈。患者被问及他们对远程医疗（电话、视频）与面对面就诊的看法。访谈的音频文件被转录，并根据访谈协议中预先确定的主题和子主题进行分析。
2021 年 7 月至 10 月，共有 15 名患者（电话=5，视频=10）同意并接受了访谈，平均年龄为 74 岁。13 名参与者表示，他们更喜欢包括远程医疗护理在内的混合护理模式，而不是仅面对面就诊。远程医疗偏好的最常见因素是 COVID-19、身体残疾和交通负担。对熟悉的面对面互动的舒适感和进行身体检查是偏好面对面就诊的常见因素。面对面就诊在初级治疗后阶段早期更为受欢迎；当患者与医疗团队关系良好且远离诊断时，远程医疗更能被接受。
关于预约方式的医患讨论应考虑到诊断的新颖性、患者对护理团队的熟悉程度、旅行负担以及进行身体检查的必要性。
