Creation of a telehealth task force to improve successful use of telehealth to maintain patient access during the COVID-19 pandemic

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Background: In response to the COVID-19 National Emergency, the Sidney Kimmel Cancer Center (SKCC) medical oncology practice desired to greatly expand telehealth (TH) utilization to decrease patient risk while maintaining access to care. TH utilization requires resources (smart phones, internet) and there are disparities in digital media access in our patient population. A digital literacy survey performed at the SKCC in 2018 noted that 30% of patients used Android phones and > 60% of patients accessed the internet from a PC. Methods: In response to increased TH demand and need for support, the SKCC launched an oncology-dedicated Telehealth Task Force (TTF) to address barriers to TH access. The TTF team consisted of nine full-time individuals with digital and healthcare literacy to assist in telehealth and patient portal troubleshooting. Critical functions of TTF’s targeted patient solutions include; set-up and delivery of smartphones, creating email accounts, performing test visits, creating EHR patient portal accounts, real- time assistance during TH visits with implementation of this intervention beginning on April 3, 2020 with monitoring of patient interactions/touchpoints. Results: The SKCC medical oncology TTF noted increased interactions with patients immediately with a marked increase in the composite of medical oncology appointments completed by TH (51.0% in April 2020 compared to a prior level of 15.7% in March 2020). Additionally, there was a statistically significant increase in the proportion of patients have an active patient portal EHR account during this same period (14.6%; 95% CI, 12.3% to 16.9%; p < 0.0001). Oncology infusion treatment appointments remained relatively consistent over time. Conclusions: The SKCC medical oncology practice experienced an exponential rise in TH utilization during an uncertain public health crisis. Disparity in digital literacy and resources essential for successful TH use were quickly appreciated as potential barriers to access. The creation of a dedicated Telehealth Task Force was critical in maintain access to care for oncology patients given their vulnerability to infection. Further investigation of TH supports to improve TH use are warranted. [Table: see text]

Abstract S11-01: Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers

Background: The COVID-19 global pandemic created significant and unprecedented disruptions in in medical care and social services. Cancer patients are at increased risk of COVID-19 infection due to their immunosuppressive state and may fare worse than others who are COVID-19 positive because of their aggressive underlying disease. While presumed to be substantial, the extent of the impact of the pandemic on cancer patients, survivors, and caregivers was unknown.

Methods: Between April 23, 2020 and May 19, 2020, our urban, NCI-designated cancer center launched a “COVID and Cancer” survey for cancer patients, survivors, and caregivers. The purpose of the survey was to assess disruptions to cancer care, use and perceptions of telemedicine, access to social services and cancer support programs, and psychosocial well-being. The online survey was distributed through our cancer center’s email list for patient and survivor programming, via the electronic patient portal to patients in active treatment, and across our cancer center’s social media platforms. Descriptive statistics reported mean scores and frequencies while bivariate statistics reported differences in outcomes by respondent characteristics. The protocol and survey were approved by our Institutional Review Board.

Results: In less than one month and in the height of the pandemic, 1,107 people completed the survey. After removing duplicate and incomplete responses, the final sample of 985 respondents included 377 (38%) patients in active treatment, 576 (56%) survivors, and 18 (2%) caregivers. Fifty-six percent (n=555) were female; the mean age of respondents was 63 years old (SD= 11.9). Seventy-two percent (n=705) of respondents had solid tumor cancers while some had either a heme malignancy (22%) or both (4%). Among the 688 respondents who needed cancer care during the pandemic, 294 (43%) reported disruptions in appointments, labs, or scans. Fewer (&lt;5%) reported disruptions in surgery, chemotherapy, or radiation. Almost half (n=335, 49%) reported a telehealth visit during this time. Most respondents (n=612, 62%) were worried about contracting COVID-19. Cancer patients who were in active treatment were significantly more likely to be worried about contracting COVID-19, as well as accessing medication, transportation, or caregiver support, than those who were not in active treatment.

Conclusions: Disruptions in cancer care were observed during the pandemic. Cancer patients in active treatment were more worried that resources needed for their care such as medication, transportation, and caregiver support would be impacted by the pandemic. At our cancer center, we tried to mitigate some of the survey observations by developing COVID-specific patient and caregiver support programs, partnering with local agencies to provide groceries and transportation to patients, and enhancing infrastructure to assist with telehealth appointments. Cancer center support services can overcome these barriers and ensure patient care, even in a pandemic.

Citation Format: Amy Leader, Preethi Selvan, Lisa Capparella, Rebecca Cammy, Janene Palidora, Ayako Shimada, Benjamin Leiby, Gregory Garber, Brooke Worster. Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S11-01.

Abstract PO-037: SKCC medical oncology telehealth experience during Covid-19 pandemic: Lessons learned and operational changes to leverage telehealth to maintain patient access

The purpose of this report is to share lessons learned at the Sidney Kimmel Cancer Center (SKCC) in response to the COVID-19 National Emergency, marked by expanding telehealth (TH) to decrease patient risk while maintaining access to care. TH utilization requires resources (smart phones/tablets, email, internet), and there are disparities in digital media access in our patient population. We learned from a digital literacy survey performed at the SKCC in 2018 that 30% of our patients used Android phones and &gt; 60% of patients accessed the internet from a PC. Our EHR was built to support a “nonpandemic” level of TH visits, which increased in a short span from 29 visits in January 2020 to 1,700 visits in April 2020. Pre-COVID, the Jefferson TH office had 5 support employees to assist patients with TH. Though some patients needed support, the TH team had a manageable caseload. During the first weeks of the pandemic, the EHR TH software was updated to accommodate increased demand, requiring PC/mobile device upgrades/setting changes, which posed a potential barrier to care. In response to increased TH demand and need for support, the SKCC launched an oncology-dedicated Telehealth Task Force (TTF) to address barriers to TH access. Examples of TTF’s targeted patient solutions include set-up and delivery of smartphones, creating email accounts, disseminating instructions for TH use, and real- time assistance during TH visits. Daily protocol for support staff across the SKCC adapted to accommodate the increase in TH visits. Phone room staff experienced increased volume of scheduling requests to change in-person visits to TH, from 165 rescheduled in March 2020 to 431 in April 2020, and established new scripting and triage protocol. Administrative staff now follows up telephonically for TH visits. Providers noted challenges in completing TH visits within predetermined appointment length due to technical delays and increased time needed for novice users. The nurse’s role in the care team was vital in reinforcing to patients the availability of TTF supports prior to their TH visits and communicating appointment delays to improve patient experience. Providers noted the need to document at the point of care as support staff rely on this to schedule testing/follow-up visits. Supportive resources for TH were quickly appreciated, such as access to forms for timely documentation of treatment consent. The SKCC experienced an exponential rise in TH use and made critical workflow adjustments as well as creating a dedicated TTF to maintain access to care for oncology patients during an uncertain public health crisis.

Citation Format: Avnish Bhatia, Lauren Waldman, Gregory Garber, Megan Sabonjian, Melissa Hunt, Janene Palidora, Amy Leader, Brooke Worster. SKCC medical oncology telehealth experience during Covid-19 pandemic: Lessons learned and operational changes to leverage telehealth to maintain patient access [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-037.