RESUMO
Background: The use of telemedicine in radiation oncology increased dramatically during the COVID-19 pandemic. While prior surveys suggest high levels of satisfaction with telemedicine among radiation oncologists, the published literature is limited regarding provider-specific factors impacting satisfaction and provider preferences regarding how telemedicine is implemented. Objective(s): To assess provider characteristics associated with satisfaction and perceived adoption of telemedicine in radiation oncology, and to characterize implementation preferences of providers at our institution. Method(s): We distributed a survey to all attending radiation oncologists at our large academic institution in October 2021 to assess several measures of satisfaction with telemedicine. We also asked providers to estimate metrics suggestive of successful telemedicine use. Univariate logistic regressions were performed to assess the role of physician characteristics (including age, gender, years in practice, main vs satellite location, disease site treated, annual new patient volume, and selfreported comfort with technology) on satisfaction and on whether physicians reported telemedicine was easy to use. We also performed descriptive statistics to characterize provider-estimated time-savings and training preferences. Kruskal-Wallis tests were used to assess whether provider characteristics or scheduling strategy (telemedicine scheduled separately from in-person visits) were associated with the rate of missed video visits. Result(s): A total of 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department and 78% felt telemedicine was easy to use. None of the tested factors on univariate analysis were statistically significant predictors for these outcomes. 38% of providers believed telemedicine encounters resulted in time savings of at least 10% compared to in-person visits, while 20% of providers reported virtual encounters took at least 10% more time. A median (IQR) of 10% (5%-20%) of video visits were estimated to be missed, and none of the tested provider characteristics or scheduling preferences were associated with a significantly greater proportion of missed visits. 78% of respondents reported having adequate training and support to perform telemedicine. Text, video, and private instruction were nearly equally preferred training modalities (31%, 31%, 34% respectively). Conclusion(s): Nearly 80% of surveyed radiation oncologists were satisfied with telemedicine, felt it was easy to use, and reported adequate training and support to perform telemedicine. In this highly technologically advanced field, age and years in practice were not significantly associated with satisfaction or self-reported success rates with telemedicine. Future directions include addressing actionable concerns and correlating these findings with patient impressions.
RESUMO
Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be utilized after the COVID-19 public health emergency (PHE) ends. Despite ongoing COVID-19 risks and public payer support for telemedicine, several private payers have stopped reimbursing telemedicine weekly see video visits. We performed a large single-institution assessment of provider perspectives on telemedicine after we had achieved a more mature level of adoption to better understand factors considered when determining to use telemedicine and to estimate the percent of visits that could be safely performed with telemedicine. We distributed a survey to all radiation oncology attendings at our large academic institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and to identify factors influencing whether telemedicine is employed. For the qualitative analysis, two authors independently coded open-ended survey responses and identified categories and themes following established content analysis methodology. We calculated the average proportion of visits that providers expected could be appropriately performed with telemedicine without a clinically significant decline in the quality of care for each disease site and visit type. 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department, and 83% wished to continue offering video visits after the COVID-19 PHE ends. Common reasons providers endorsed for wanting to integrate telemedicine into practice included: patient and provider preference, increased access to care and clinical trials, allowing for greater relationship with the care team, and improved clinical safety, efficiency, and quality. Patient factors influencing whether physicians offer telemedicine included the patient's travel burden, patient preferences, and whether a physical exam is required. About 20% of new consultations and 50% of weekly management visits were estimated to be clinically appropriate for telemedicine. Central Nervous System/Pediatrics and Thoracic faculty considered telemedicine appropriate for the greatest proportion (50%) of new consultations. 93% of respondents felt comfortable determining whether telemedicine was appropriate. Surveyed radiation oncologists were satisfied with telemedicine in their practice and wished to continue offering video visits in the future. Although provider perceptions of clinical appropriateness of telemedicine varied widely based on disease site and visit type, providers felt comfortable determining when telemedicine would be appropriate for patients. Our data suggest payers should continue to support this patient-centered technology. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)