Age, Race, and Digital Divide Index are Associated With Video Visit Completion for Patients Seen in Radiation Oncology

The COVID-19 pandemic drove rapid adoption of telehealth across medicine, including radiation oncology, to minimize in-person contact. This exposed patient barriers to telehealth access and created care disparities in the absence of specific access assistance which have been little studied. A better understanding of these telehealth access barriers will help direct assistance resources to improve access in radiation oncology patients in the future. Data for all unique patient visits at a large academic medical center between 4/1/2020 and 6/30/2020 were generated, including visit type (in person, video, audio only), age, race, ethnicity, rural/urban home address (zip code assessment by Federal Office of Rural Health Policy), and Digital Divide Index (DDI;incorporates metrics of technology and internet access, age, disability, and educational attainment in a geographic area). A multivariable logistic regression model evaluated the association of these variables with successful video visit completion. A total of 1990 visits by patients seen in radiation oncology for 1698 unique individuals were assessed. The median age was 66 (IQR: 14);patients were 38.1% female and 89.4% Caucasian. The median age of those completing at least one video visit was 64 (IQR: 15) vs. 68 (IQR: 14) for those who completed audio visits only (P < 0.001). Among African American patients, 22.7% completed at least one video visit, while 36.7% of Caucasian patients completed at least one video visit (P = 0.003). In multivariable analyses, patient age (OR: 0.965;95% CI 0.956-0.973;P < 0.001), DDI (OR: 0.986;95% CI 0.976-0.996;P = 0.006), and race (OR: 0.472;0.294-0.756;P = 0.039) predicted completion of at least one video visit. Those who were older, had higher DDI (greater digital divide), or African American race were less likely to complete a video visit. Gender, ethnicity, and rural/urban home address were not significantly associated with video visit completion. This work is to our knowledge the first characterization of telehealth usage in radiation oncology patients and demonstrates associations between patient characteristics and video visit completion that have implications for clinical practice and future research. First, older patients, those with minority backgrounds, and those from areas with less access to technology (high digital divide) are less likely to be able to access care through video visits. Second, audio visits were a significant proportion of visits early in the pandemic, and subsequent data should be analyzed to determine their importance as a means to continue providing virtual care to prevent further care disparities. Third, future research is needed to address barriers to care experienced by elderly and minority patients as well as those from communities with high DDI. Fourth, researchers should explore markers of access barriers such as DDI and other potential pre-visit screening metrics for use in directing resources to those in need. [ABSTRACT 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 abstract 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 abstract. (Copyright applies to all Abstracts.)