Y. Sharifzadeh1, W. S. Harmsen2, J. F. Burlile1, A. Amundson1, M. R. Waddle1, D. M. Routman1, A. E. Garda1, K. W. Merrell1, C. L. Hallemeier1, A. Kollengode1, E. J. Cleveland1, N. N. Laack II1, K. S. Corbin1, and W. Breen1; 1Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 2Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
Purpose/Objective(s): One-third of older adults report lack of readiness to use telemedicine (TM). Video technology utilization by older adults presenting for radiation oncology consultation has not been studied. We examined older adults who presented to a comprehensive cancer for consultation in-person (IP) or via video (VI) during the COVID-19 pandemic. We hypothesized that younger age, lower area deprivation index (ADI), and farther distance from clinic would be associated with older adults’ use of video technology and that IP and VI visits would have equivalent patient satisfaction scores (PSS). Materials/
Methods: All new patient consultations 65 years or older from March 2020 to December 2021 were identified. Visits were categorized as IP or VI. Sex, age, distance from clinic, and ADI (1 [least deprived] – 100 [most deprived]) by zip code were collected. PSS (top box: percentage of patients giving 5 out of 5 for a question) from April 2020 to December 2021 for 628 IP and 226 VI were available. Results: Among the 5,382 patients, 4,416 (82%) were IP, 966 (18%) were VI, and 64% were male with a median age of 73 years (IQR 69 – 77). VI patients had a lower percentage of female patients (39% IP, 23% VI), lived significantly farther away from clinic (median miles 95 IP, 267 VI), were younger in median age (73 years IP, 72 VI), and had a lower median ADI (49 IP, 42 VI). Multivariable logistic regression comparing VI to IP patients showed that VI patients were significantly younger (OR 0.98, p < 0.001) and lived farther from clinic (OR 1.14, p < 0.001). ADI was not significantly different (OR 0.97, p = 0.051). Across eight patient satisfaction domains, average top-box scores for IP and VI were 86.2 and 85.8, respectively. IP and VI PSS were similar in categories assessing satisfaction with care and the care provider (for example “care provider showed concerned for my questions/worries,” “care provider discussed treatments,” “care provider made efforts to include me in decisions,” and likelihood of recommending care provider and the general experience). However, VI PSS was 5.7% lower in “ease of scheduling appointments.” It is unknown whether this stemmed from VI patients desiring a visit type other than video (i.e. the patient wanted an in-person visit but could not obtain one) or general dissatisfaction with scheduling VI appointments. Conclusion: Eighteen percent of older cancer patients presenting for consultation utilized video TM services. VI patients were more likely to be younger and live significantly farther away with similar ADI. PSS scores were similar on average, but VI patients expressed scheduling challenges. Our findings suggest that TM services can improve access to care by reaching patients at greater distances with good overall satisfaction. However, we rely on continued advancements in TM infrastructure to improve the ease of using and scheduling TM visits. Also, expansion of TM use may benefit medically underprivileged older adults.
