Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cancer. 2024 Feb 15;130(4):636-644. doi: 10.1002/cncr.35116. Epub 2023 Nov 21.
Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality.
This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits.
The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38).
In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.
尽管远程医疗已经得到广泛应用，但关于其对绝症或高危癌症患者护理关键组成部分的影响的数据有限。对于这些患者，高质量的护理需要就治疗重点（预先护理计划）和临床护理进行详细的讨论，以尽量减少不必要的急性护理（非计划性住院）。在宾夕法尼亚大学，研究人员对癌症风险高的患者进行了一项回顾性队列研究，以检验远程医疗相对于门诊就诊是否会对这些结果产生影响。
本项回顾性队列研究纳入了宾夕法尼亚大学治疗的任何肿瘤类型的癌症成年患者，这些患者通过一种经过验证的机器学习算法被新识别为有 6 个月内死亡风险。分别使用修正泊松回归来评估与门诊就诊相比，远程医疗发生预先护理计划和非计划性住院的情况。还进行了额外的分析，比较了远程医疗类型（视频或电话）与门诊就诊的比较。
与门诊就诊相比，远程医疗发生预先护理计划的情况相似（6.8%比 6.0%；调整后的风险比[aRR]，1.25；95%CI，0.92-1.69）。在远程医疗亚型方面，与门诊就诊相比，接受视频就诊的患者记录预先护理计划的可能性略高（7.5%比 6.0%；aRR，1.48；95%CI，1.03-2.11）。与门诊就诊相比，远程医疗的 3 个月非计划性住院风险相当（21%比 18%；aRR，1.06；95%CI，0.81-1.38）。
在这项研究中，与门诊就诊相比，远程医疗提供的护理产生了相当比例的预先护理计划对话，而没有增加住院率，这表明脆弱的患者可以通过远程医疗安全地进行管理。
