Patient and Clinician Perspectives on Expanding Telehealth Use for Older Adults Across the Cancer Control Continuum: Mixed Methods Study.

Background: Reliance on telehealth increased dramatically during the COVID-19 pandemic, introducing new opportunities to consider the use of telehealth across the cancer control continuum. However, patient, clinician, and staff perspectives about the types of cancer care appointments that are considered appropriate and the clinical care needs to support expanded remote care services are limited. Understanding older adults' diverse technology needs and perspectives is especially important given that they comprise a large and growing proportion of patients with cancer. Objective: This study aimed to describe the perceptions and experiences of older patients with cancer and their clinical care team members regarding the expansion of telehealth use across the cancer control continuum and to solicit suggestions about how to support telehealth use for cancer care delivery. Methods: Using a convergent mixed methods design, we surveyed and interviewed patients aged ≥60 years, clinicians, and staff at a comprehensive cancer center in the southern United States between December 2020 and November 2021. Interview questions were rooted in the sociotechnical model, which proposes 8 interrelated dimensions representing factors influencing the design, use, and outcomes associated with health information technologies. Patient survey domains included telehealth experience and satisfaction and factors affecting telehealth perceptions and use; clinician survey domains included contexts of telehealth appropriateness, training, and barriers and facilitators to telehealth service provision. Survey data were analyzed using descriptive statistics. Qualitative data were thematically analyzed using a combined deductive and inductive approach. Results: We received completed surveys from 128 patients (567 invited) and 106 clinicians and staff (146 invited). We completed 14 patient (29 invited) and 20 clinician and staff (22 invited) interviews. Across all participants, most agreed or strongly agreed that multiple cancer care appointment types should be offered via telehealth, including discussing treatment side effects (75/102, 73.5% of patients and 66/94, 70.2% of clinicians and staff), results communication (71/102, 69.6% of patients and 65/94, 69.1% of clinicians and staff), and treatment follow-up (67/102, 65.7% of patients and 52/93, 55.9% of clinicians and staff). In interviews, participants elaborated on factors influencing the appropriateness of telehealth versus in-person appointments, including symptom severity, type of cancer, and purpose of the appointment. Many patient and staff suggestions focused on ways to address digital literacy gaps, while clinicians recommended improving clinic workflows, infrastructure, and training. Conclusions: Overall, clinicians, staff, and older patients with cancer all responded positively toward expanding telehealth use across multiple cancer and appointment types across the cancer control continuum. Older adults with cancer are generally interested in telehealth for cancer care, especially if strategies to address digital literacy gaps are incorporated. Clinicians and staff members expressed specialized training and infrastructure needs to optimize telehealth uptake and service delivery.