In 2018, telemedicine was not at the forefront in medicine for many, but some knew that for our rural communities, it could make a world of difference. Drs. Susan Miesfeldt of Maine Medical Center/MaineHealth and Nan Solomons of the University of New England assessed whether cancer genetic services were equally effective via telehealth consults as in-person appointments from the patient’s point of view. Their study highlighted both the need and benefits of telemedicine for remote patients far before the pandemic came into play.
In 2018, telemedicine was not at the forefront in medicine for many, but some knew that for our rural communities, it could make a world of difference. Drs. Susan Miesfeldt of Maine Medical Center/MaineHealth and Nan Solomons of the University of New England assessed whether cancer genetic services were equally effective via telehealth consults as in-person appointments from the patient’s point of view. Their resulting publication, “Examination of the Patient-Focused Impact of Cancer Telegenetics Among a Rural Population: Comparison with Traditional In-Person Services,” highlighted both the need and benefits of telemedicine for remote patients far before the pandemic came into play.
“We realized we were not reaching many of our rural cancer families.” - Dr. Susan Miesfeldt
Sue says rural patients face barriers to accessing the cancer genetic services her team provides at Maine Medical Center (MMC). “In our rural communities, there are the barriers of geographic distance, often needing to get the whole day off work to travel a long way, paying a babysitter for the day, or asking a family member to take a day off to watch kids. There is a lot more that rural patients have to deal with to get to appointments.” To increase access to this critical care for rural cancer patients, through seed funding from the Maine Cancer Foundation, they leveraged telecommunication where a local regional health center would connect patients with their specialists at MMC. Technological support was provided by regional clinic staff so remote patient appointments could run as smoothly as possible, letting patients focus on their own personal questions.
Nan and Sue found that 100% of remote patients were happy with their telegenetic services, and 98% said they’d use telemedicine again. “The most important thing was the finding that satisfaction of our telecommunication patients was so high, and that a small proportion said they’d prefer to have an appointment in person,” says Nan. They also found that patient knowledge was equal among remote and in-person patients, echoing other reports that telehealth can be an effective option for medical care. Telegenetic counseling also reduced anxiety and depression in remote patients similar to what was reported by in-person patients. These findings established telemedicine as an effective option for rural cancer genetic patients, but telehealth services aren’t as simple as many might think.
“This work really foreshadowed what we’re seeing now in COVID. It gave us the framework of what needs to be done for telehealth to be effective, and it’s a lot.” - Dr. Nan Solomons
In their study, remote patients still traveled to a regional center where staff would provide technological support needed to connect patients with their cancer genetic providers. With the COVID-19 pandemic, even this type of telemedicine was impacted. “We were forced to take that leap, and now almost all of our cancer genetic counseling patients are in zoom telehealth appointments from their homes or other sites, including, on occasion, their cars or work sites,” says Sue. However, we don’t yet know whether these fully remote appointments are as effective as in-person or regional remote care provided pre-pandemic. We first have to consider how much work is needed to provide effective teleservices.
“We need someone collecting records, interfacing with patients, patients learning about zoom, doing test calls. ... There’s a lot of preparation and a lot of human capacity needed to make sure this connection can work.” - Dr. Nan Solomons
When asked how we can better ensure telehealth services are adequately supporting patients, Nan and Sue emphasized what physicians need to make this happen. First, they need more training on how to run an exam or engage with patients without being in the room. Beyond that, Sue says they need administrative and technology support, and sites need careful data collection and funding to support the demands of telemedicine. “One of the pieces we needed to build our telehealth program was seed grant funding. This isn’t something that just happens, something that providers can do on their own. We learned that the infrastructure has to be carefully developed first. This can’t be left to physicians alone.” Indeed, when Sue and Nan were developing their study, it took time to find outreach sites prepared to use telemedicine. Telehealth was newer in 2018, and providers knew how much extra support and resources would be needed to ensure it was effective. Then from the patient perspective, there’s also the issue of technology.
“What we’re finding now is that the patient experience is almost always dependent on the tech and not the actual care,” Nan said. In our predominantly rural region, where the majority of homes do not have the bandwidth to support multiple devices at once, this is a significant barrier. The COVID-19 pandemic has indeed highlighted the many challenges and problems with telemedicine, but Nan and Sue know that if given the necessary time and resources, telehealth services can be an effective and satisfying option for remote patients.
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Read the Paper: Solomons, NM, Lamb, AE, Lucas, FL, McDonald, EF, & Miesfeldt, S (2018). Examination of the Patient-Focused Impact of Cancer Telegenetics Among a Rural Population: Comparison with Traditional In-Person Services. Telemedicine Journal and E-Health, 24(2), 130–138.