Telehealth in Uro-oncology Beyond the Pandemic: Toll or Lifesaver?
Adult
Aged
Aged, 80 and over
Anxiety
Attitude to Health
Betacoronavirus
COVID-19
Coronavirus Infections
/ epidemiology
Female
Humans
Kidney Neoplasms
/ therapy
Male
Medical Oncology
Middle Aged
Pandemics
Patient Acceptance of Health Care
Patient Preference
Physician-Patient Relations
Pneumonia, Viral
/ epidemiology
Program Evaluation
Prostatic Neoplasms
/ therapy
SARS-CoV-2
Telemedicine
Time-to-Treatment
Urinary Bladder Neoplasms
/ therapy
Urogenital Neoplasms
/ therapy
Urology
COVID-19
Patient perspective
Telehealth
Uro-oncology
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
15 Sep 2020
15 Sep 2020
Historique:
received:
06
05
2020
accepted:
26
05
2020
pubmed:
15
6
2020
medline:
21
8
2020
entrez:
15
6
2020
Statut:
ppublish
Résumé
Telehealth services are rapidly embraced in uro-oncology due to the current coronavirus disease 2019 (COVID-19) pandemic. To determine patients' perspective on adoption of telehealth as a response to the pandemic and its sustainability in the future. Following a COVID-19 outbreak, 101 patients with advanced genitourinary cancers are currently managed "virtually" for therapy administration at our tertiary care unit. They were surveyed about the current situation, and current and long-term employment of telehealth. Rapid implementation of virtual patient management. Patients' perception of anxiety of COVID-19 and cancer, perspective on telehealth measures as a reaction to the current COVID-19 pandemic, and long-term acceptance were used as outcomes. Wilcoxon matched-pair signed rank test, chi-square test, and Mann-Whitney U test were performed. Of 101 patients, 92 answered the questionnaire, with 71 (77.2%) responding virtually by e-mail or phone call. Anxiety of cancer (6/10, interquartile range [IQR] 3-8) superseded that of COVID-19 (four/10, IQR 2-5.25, p<0.001), and patients oppose temporary treatment interruption. Of the patients, 66.0% perceive their susceptibility to COVID-19 as equal to or lower than the general population and 52.2% believe that COVID-19 will not affect their therapy. In future, patients (62.6%) prefer to maintain in-person appointments as opposed to complete remote care, but accept remote care during the pandemic (eight/10, IQR 5-9). Beyond the crisis, maintaining telehealth has low preference rates (four/10, IQR 2-7), with high acceptance for external laboratory controls (60.9%) and online visit management (48.9%), but lower acceptance for remote treatment planning including staging discussions (44.6%) and for referral to secondary care oncologists (17.4%). Despite the pandemic, cancer remains the key concern and patients are not willing to compromise on their treatment. Rapid implementation of telehealth is tolerated well during the need of social distancing, with a clear "red line" concerning changes in existing patient-physician relationships. Balancing future implementation of telehealth while considering patients' demand for personal relationships will ensure human dignity in uro-oncology. We queried patients with genitourinary cancers treated in an almost virtual setting following a local coronavirus outbreak. Acceptance of telehealth during the current situation is high; however, long-term implementation of the adapted services is less favored. We deduce that patient-physician relationship is crucial for cancer patients and needs to be balanced against measures for social distancing to forge the future management.
Sections du résumé
BACKGROUND
BACKGROUND
Telehealth services are rapidly embraced in uro-oncology due to the current coronavirus disease 2019 (COVID-19) pandemic.
OBJECTIVE
OBJECTIVE
To determine patients' perspective on adoption of telehealth as a response to the pandemic and its sustainability in the future.
DESIGN, SETTING, AND PARTICIPANTS
METHODS
Following a COVID-19 outbreak, 101 patients with advanced genitourinary cancers are currently managed "virtually" for therapy administration at our tertiary care unit. They were surveyed about the current situation, and current and long-term employment of telehealth.
INTERVENTION
METHODS
Rapid implementation of virtual patient management.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
METHODS
Patients' perception of anxiety of COVID-19 and cancer, perspective on telehealth measures as a reaction to the current COVID-19 pandemic, and long-term acceptance were used as outcomes. Wilcoxon matched-pair signed rank test, chi-square test, and Mann-Whitney U test were performed.
RESULTS AND LIMITATIONS
CONCLUSIONS
Of 101 patients, 92 answered the questionnaire, with 71 (77.2%) responding virtually by e-mail or phone call. Anxiety of cancer (6/10, interquartile range [IQR] 3-8) superseded that of COVID-19 (four/10, IQR 2-5.25, p<0.001), and patients oppose temporary treatment interruption. Of the patients, 66.0% perceive their susceptibility to COVID-19 as equal to or lower than the general population and 52.2% believe that COVID-19 will not affect their therapy. In future, patients (62.6%) prefer to maintain in-person appointments as opposed to complete remote care, but accept remote care during the pandemic (eight/10, IQR 5-9). Beyond the crisis, maintaining telehealth has low preference rates (four/10, IQR 2-7), with high acceptance for external laboratory controls (60.9%) and online visit management (48.9%), but lower acceptance for remote treatment planning including staging discussions (44.6%) and for referral to secondary care oncologists (17.4%).
CONCLUSIONS
CONCLUSIONS
Despite the pandemic, cancer remains the key concern and patients are not willing to compromise on their treatment. Rapid implementation of telehealth is tolerated well during the need of social distancing, with a clear "red line" concerning changes in existing patient-physician relationships. Balancing future implementation of telehealth while considering patients' demand for personal relationships will ensure human dignity in uro-oncology.
PATIENT SUMMARY
RESULTS
We queried patients with genitourinary cancers treated in an almost virtual setting following a local coronavirus outbreak. Acceptance of telehealth during the current situation is high; however, long-term implementation of the adapted services is less favored. We deduce that patient-physician relationship is crucial for cancer patients and needs to be balanced against measures for social distancing to forge the future management.
Identifiants
pubmed: 32534969
pii: S2405-4569(20)30145-0
doi: 10.1016/j.euf.2020.05.010
pmc: PMC7286644
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1097-1103Informations de copyright
Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Références
Clin Genitourin Cancer. 2021 Feb;19(1):76-82.e6
pubmed: 32527682
J Telemed Telecare. 2018 Jan;24(1):4-12
pubmed: 29320966
Eur Urol. 2020 Jun;77(6):667-668
pubmed: 32312544
Lancet. 2020 Apr 25;395(10233):1382-1393
pubmed: 32277878
N Engl J Med. 2020 Apr 30;382(18):1677-1679
pubmed: 32109012
N Engl J Med. 2020 Jun 11;382(24):2285-2287
pubmed: 32267650
N Engl J Med. 2020 Apr 30;382(18):1679-1681
pubmed: 32160451
Lancet Oncol. 2020 Mar;21(3):335-337
pubmed: 32066541
JAMA. 2017 Jul 11;318(2):197-198
pubmed: 28586821
Psychol Sci. 2015 Feb;26(2):135-47
pubmed: 25526910
Eur J Cancer. 2020 Jun;132:136-140
pubmed: 32361628
NPJ Digit Med. 2019 Jun 14;2:53
pubmed: 31304399
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
AMIA Annu Symp Proc. 2015 Nov 05;2015:543-52
pubmed: 26958188
Eur J Cancer. 2020 Jun;132:17-23
pubmed: 32311643
N Engl J Med. 2020 Jun 4;382(23):e82
pubmed: 32240581
Clin Transl Oncol. 2018 Nov;20(11):1392-1399
pubmed: 29611043
N Engl J Med. 2020 Jun 11;382(24):2368-2371
pubmed: 32302076
N Engl J Med. 2020 Aug 6;383(6):510-512
pubmed: 32283003