There is considerable interest in the potential of virtual solutions to improve the accessibility, patient-centredness and cost-effectiveness of cancer care and psychosocial support. Virtual care demonstration projects have shown high levels of satisfaction among patients and providers. Patients value the convenience, time and cost savings of virtual care, while providers find it useful for reaching a wider patient population and providing patient-centred care. Despite these promising findings, the adoption of virtual care/ support has been slow due to fears that it may be less safe or acceptable, as well as technical, logistical and regulatory challenges. Further, virtual care may increase healthcare disparities by widening the digital divide.
The transition to virtual care/support in response to the COVID19 pandemic presents an ideal opportunity to examine its acceptability. This symposium will begin with an in-depth look at virtual cancer care usage patterns and patient and provider perspectives at the Princess Margaret Cancer Centre (PM). Next, we will examine the adaptations made to deliver virtual cancer rehabilitation at PM, and explore patient and provider experiences. Finally, we will explore client perspectives on virtual community-based support programs at Wellspring. The symposium will conclude with a discussion of priorities for future research and practice.
Wellspring Cancer Support Foundation provides community-based support to meet the emotional, physical, practical, and informational needs of cancer patients and caregivers. In response to the COVID-19 pandemic, all support programs were adapted for virtual access. Virtual programs included support groups, psycho-educational webinars, individual counselling, and self-paced learning. Wellspring undertook an evaluation to understand barriers to access, uptake, ease of access, satisfaction, and perceived benefit compared to in-person programming.
Metrics collected included new memberships, registered program attendance, video views and resource downloads. An electronic survey was distributed to 3722 individuals who had completed memberships between September 2019 and October 2020. Within this group were individuals who; participated only in-person, only virtual or both virtual and in-person.
Between April and October 2020, virtual programs had a total of 27,177 visits, video views and resource downloads. New memberships were received from 10 provinces/territories. A total of 621 members responded to the survey. Barriers to accessing virtual programs included a focus on other priorities (35%), preference for in-person programs (28%) and lack of awareness (25%). Satisfaction with virtual programs was strong (registered groups-97%, webinars-96%). Respondents accessing virtual programs indicated they were coping better (87%) and feeling less isolated (81%). 95% of respondents found programs easy to access, with 85% expressing minimal technical difficulties. 87% of respondents indicated a desire for virtual programs post-pandemic.
Overall, virtual program delivery was successful, resulting in a wider audience across Canada, similar outcomes to in-person programming and a confirmed desire for continued virtual delivery post-pandemic.
To describe the adaptations and modifications made to deliver virtual cancer rehabilitation at the onset of the COVID-19 pandemic and understand the experiences of patients and providers adapting to virtual care.
Sample and setting: Patients attending the Cancer Rehabilitation and Survivorship Program (Princess Margaret Cancer Centre Cancer) during the first 90 days of the COVID-19 pandemic.
Procedure: Data collection included a framework-driven categorization of modifications made to the program and qualitative interviews with patients and providers. Program data on service delivery of virtual care was compared to the previous 90 days of in-person care.
1968 virtual patient visits were completed during the study period. The majority of visits were able to be adapted to virtual delivery. Modifications to the program included format changes, setting changes, and content changes. Virtual care demonstrated a decrease in wait times and an increase in capacity for a variety of visit types. There was an increase/maintenance in the number of completed visits compared to in-person care, with attendance rates ranging from 80-93%. Three themes emerged from the interviews and include: 1) access to care; 2) meeting support needs; and 3) confidence with assessment and care plan. The interviews revealed that virtual care was an acceptable alternative that provided timely access to care and needed support.
Findings suggest that many appointments can be successfully adapted to virtual formats to deliver cancer rehabilitation programming. We provide several practical recommendations that can be implemented by clinicians and programs to facilitate the adoption and delivery of virtual care.
To gain insight into the acceptability of virtual cancer care (VCC) among patients and providers during the COVID19 pandemic.
Two surveys were distributed at the Princess Margaret Cancer Centre. Patients (n=2,627) completed the Your Voice Matters survey adapted for VCC following appointments between Aug-Dec 2020, and providers (n=158) completed a VCC evaluation survey within two months of VCC launch. 171 VCC related open-ended responses were collected from patients, and 90 from providers. Quantitative responses were analyzed using descriptive statistics, and qualitative open-ended responses were thematically analyzed.
A total of 635 (25%) patients had a virtual visit; 107 (17%) via video and 522 (83%) via phone. The majority of patients (565; 89%) and providers (111;70%) were satisfied or very satisfied with VCC. Of all patient respondents, 1,414 (53.2%) would ask for a virtual visit for their next appointment. Four themes emerged from patients’ open-ended responses: 1) greater accessibility and convenience; 2) scheduling and follow-up communication breakdowns; 3) need for improved functionality; and 4) concerns about care quality and safety. Three themes emerged from providers’ open-ended responses: 1) support for virtual care; 2) need for improved functionality; and 3) concerns about care quality and coordination.
Patients and providers expressed high levels of satisfaction with VCC, but some raised concerns about technological functionality and the impact on care processes and quality. Recommended improvements include virtualizing care workflows to optimize coordination and efficiency, and to enable patients to participate more actively in their care.