Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: Despite demonstration of telehealth feasibility, accessibility, and satisfaction among patients with various chronic diseases, there remains low acceptability among HNC patients. There is a critical gap in our understanding of patients’ perceived barriers to telehealth and potential health system approaches to address barriers.
Objective: Elucidate perceptions surrounding telehealth for oncologic surveillance among patients with head and neck squamous cell carcinoma (HNSCC).
Design, Participants, and Setting: Qualitative study using semi-structured interview conducted from 1/15/24-2/15/24 with patients treated for HNSCC at a tertiary medical center. Eligibility included: ³18 years, English speaking, 3-24 months post-treatment for mucosal HNSCC (oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, sinonasal), and without current evidence of disease. Interviews were conducted until thematic saturation. Interviews were audio-recorded, transcribed, and analyzed from 4/1/24-8/2/24 using a conventional content analysis approach.
Main Outcomes and Measures: Interviews explored patient perceptions of the acceptability and barriers to receiving telehealth-delivered surveillance care, including questions about a proposed hybrid surveillance model. Patients completed a survey including demographic questions and the following measures: the BRIEF Health Literacy Screen, scale 8-20 with lower score representing lower literacy; the Oncology Opportunity Cost Assessment Tool [(OOCAT), with 3 subscales of minimizing costs (scale 1-7), life impact (scale 1-7), and risk stress of infection / cleanliness / concern about medical errors (scale 1-10), lower scores represent less opportunity cost]; and the COmprehensive Score for financial Toxicity [(COST), 11-items scored 0-44, lower scores represent worse FT].
Results: The 24 participants had mean age 60 (range 41-77) with 16 [67%] male and 20 [83%] White. Median BRIEF health literacy and COST scores were 19 (range 8-20) and 26.5 (range 6-38), respectively. Mean OOCAT scores were minimizing costs 4.4 (SD 2.2), life impact 2.4 (SD 2.0) and risk stress 2.5 (SD 2.6).
Interview findings suggested many patients felt telehealth was acceptable for routine care (reviewing tests, refilling medication). Barriers included mainly technology challenges, especially for older patients. Most patients preferred in-person care for surveillance expressing concern regarding comprehensiveness of virtual exam. Patients were more open to a hybrid model after 2 years post-treatment.
Conclusions and Relevance: Findings demonstrate that, among the population engaged, telehealth has potential utility for HNC care for routine care needs. Primary barriers included concerns regarding inadequacy of virtual assessments for surveillance monitoring and technological challenges. Patients viewed a hybrid model combining in-person and telehealth appointments as potentially acceptable for surveillance beyond 2 years post-treatment. It is notable that the population engaged reported overall high health literacy, low financial toxicity of treatment and minimal concern related to opportunity cost of seeking treatment, and thus findings may vary in other populations in which the perceived burden of seeking care is greater. Patient preferences must be carefully considered when considering incorporation of telehealth into treatment in this population.