Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
Weill Cornell Medical College, New York, NY.
JCO Oncol Pract. 2024 Aug;20(8):1091-1102. doi: 10.1200/OP.23.00608. Epub 2024 Apr 29.
Evidence suggests that oncology patients are satisfied with and sometimes prefer telemedicine compared with in-person visits; however, data are scarce on when telemedicine is appropriate for specific cancer populations. In this study, we aim to identify factors that influence patient experience and appropriateness of telemedicine use among a head and neck cancer (HNC) population.
We performed a mixed-methods study at a multisite cancer center. First, we surveyed patients with HNC and analyzed factors that may influence their telemedicine experience using multivariate regression. We then conducted focus groups among HNC oncologists (n = 15) to evaluate their perception on appropriate use of telemedicine.
From January to December 2020, we collected 1,071 completed surveys (response rate 24%), of which 551 first unique surveys were analyzed. About half of all patients (56%) reported telemedicine as "same or better" compared with in-person visits, whereas the other half (44%) reported "not as good or unsure." In multivariate analyses, patients with thyroid cancer were more likely to find telemedicine "same or better" (adjusted odds ratio, 2.08 [95% CI, 1.35 to 3.25]) compared with other HNC populations (mucosal/salivary HNC). Consistently, physician focus group noted that patients with thyroid cancer were particularly suited for telemedicine because of less emphasis on in-person examinations. Physicians also underscored factors that influence telemedicine use, including clinical suitability (treatment status, visit purpose, examination necessity), patient benefits (travel time, access), and barriers (technology, rapport-building).
Patient experience with telemedicine is diverse among the HNC population. Notably, patients with thyroid cancer had overall better experience and were identified to be more appropriate for telemedicine compared with other patients with HNC. Future research that optimizes patient experience and selection is needed to ensure successful integration of telemedicine into routine oncology practice.
有证据表明，与面对面就诊相比，肿瘤患者对远程医疗感到满意，有时甚至更喜欢远程医疗；然而，关于远程医疗何时适用于特定癌症人群的数据却很少。在这项研究中，我们旨在确定影响头颈部癌症（HNC）患者远程医疗体验和远程医疗使用适宜性的因素。
我们在一家多地点癌症中心进行了一项混合方法研究。首先，我们调查了 HNC 患者，并使用多元回归分析了可能影响他们远程医疗体验的因素。然后，我们对 HNC 肿瘤学家（n=15）进行了焦点小组讨论，以评估他们对远程医疗适宜性的看法。
2020 年 1 月至 12 月期间，我们共收集了 1071 份完成的调查（响应率为 24%），其中分析了 551 份首次唯一调查。约有一半的患者（56%）表示远程医疗与面对面就诊“一样好或更好”，而另一半（44%）则表示“不如面对面就诊或不确定”。在多变量分析中，与其他 HNC 人群（黏膜/涎腺癌）相比，甲状腺癌患者更有可能认为远程医疗“一样好或更好”（调整后的优势比，2.08[95%CI，1.35 至 3.25]）。同样，医生焦点小组指出，甲状腺癌患者特别适合远程医疗，因为对面对面检查的重视程度较低。医生还强调了影响远程医疗使用的因素，包括临床适宜性（治疗状况、就诊目的、检查必要性）、患者获益（就诊时间、就诊机会）和障碍（技术、建立医患关系）。
HNC 患者对远程医疗的体验存在差异。值得注意的是，与其他 HNC 患者相比，甲状腺癌患者的总体体验更好，且更适合远程医疗。需要进一步研究如何优化患者体验和选择，以确保远程医疗成功融入常规肿瘤学实践。
