Cancer care telehealth utilization rates and provider attitudes in the wake of the novel coronavirus pandemic: The Kaiser Permanente Northern California experience

Background: In response to the SARS-CoV-2 pandemic, the multidisciplinary care of cancer patients has rapidlyevolved This study aims to determine utilization trends of in-person, telephone, and video visits, before and afterthe California shelter-in-place (SIP) orders on 3/19/20, and assess perspectives of cancer care providers ontelehealth Methods: This study was conducted in 22 medical centers of a large integrated health care system Utilization ofdifferent visit types in medical oncology (excluding infusion visits) was collected between 12/1/2019-5/24/2020, for atotal of 104,588 visits Chi-square with Yates correction was used for p-values Voluntary, anonymous electronicsurveys were sent to 276 cancer care providers measuring attitudes and experiences with telehealth Overall, 68 8%responded: 101/128 medical oncologists (MedOnc), 34/37 radiation oncologists (RadOnc), 16/62 breast surgeons(Brst Surg), 18/28 breast oncology nurse navigators (OncNav), and 21/21 cancer survivorship advancedpractitioners (SurvOnc) Results: Comparing visit types prior to and after SIP, in-person visits went from 55 3% to 3 3%, telephone visitswent from 44 2% to 79%, and video visits went from 0 5% to 17 8% (p< 0001) Between 12/2019 and 05/2020, video visits increased from 0 42% to 31 3% Telephone visits increased from 39 3 to a peak of 86 6% in 04/2020 andthen decreased to 63 7% In-person visits dropped from 60 3% to 2 3% in 04/2020 and then increased to 5 0%(p< 0001) Satisfaction with telehealth was high: 87 1% of MedOnc, 91 2% of RadOnc, 68 6% of BrstSurg, 72 2% ofOncNav, and 90 4% SurvOnc providers were very or somewhat satisfied Most providers preferred to increase ormaintain telehealth utilization after the pandemic: 84% of MedOnc, 85% of RadOnc, 81% of BrstSurg, 51% ofOncNav, and 90% of SurvOnc Among most providers, highest cited benefits of telehealth included work from home, reduced commute, staying on time, flexible hours, and shorter visits Commonly cited challenges includedconnection/equipment problems, need for physical exam, difficulty evaluating performance status, and in-personvisit required anyway Of MedOnc, 11 8% responded that a patient suffered an adverse effect that could have beenprevented with in-person visit In-person visits were thought to promote the strongest provider-patient connection, followed by video, telephone visits, and emails MedOnc providers deemed in-person visits were needed for end-of-life discussion (49%), discussing a new diagnosis (47 1%), palliative care discussion (34 3%), and clinical trialenrollment (34 3%) Activities for which email or phone visits were most accepted included check-in pretreatment, survivorship planning/follow-up, and patient navigation Conclusion: Overall, telehealth utilization has rapidly increased and is well accepted by various cancer careproviders Addressing technical issues and tailoring visit type to specific activities may further promote telehealthadoption and satisfaction