Compliance with Specialist Referral for Increased Cancer Risk in Low-Resource Settings: In-Person vs. Telehealth Options

SIMPLE SUMMARY: Most individuals are diagnosed after systemic spread of oral cancer, when treatment options and outcomes remain poor. Poor screening accuracy and lack of specialist access constitute critical barriers to improving outcomes, especially with high-risk individuals who typically have low resources and poor access to health care. The goal of this study was to investigate the impact on referral compliance in 60 subjects who had chosen either a novel in-home telehealth-specialist visit or a conventional in-person specialist visit. After 6 months, 30% of subjects had completed an in-person visit, vs. 83% who had completed a telehealth visit. Overall, 72.5% of subjects who had chosen a remote first specialist visit had received diagnosis and a treatment plan by the study end, vs. 25% of individuals in the in-person specialist group. A two-step approach that uses telehealth to overcome barriers may improve specialist referral compliance in low-resource individuals with increased OC risk. ABSTRACT: Efforts are underway to improve the accuracy of non-specialist screening for oral cancer (OC) risk, yet better screening will only translate into improved outcomes if at-risk individuals comply with specialist referral. Most individuals from low-resource, minority, and underserved (LRMU) populations fail to complete a specialist referral for OC risk. The goal was to evaluate the impact of a novel approach on specialist referral compliance in individuals with a positive OC risk screening outcome. A total of 60 LRMU subjects who had screened positive for increased OC risk were recruited and given the choice of referral for an in-person (20 subjects) or a telehealth (40 subjects) specialist visit. Referral compliance was tracked weekly over 6 months. Compliance was 30% in the in-person group, and 83% in the telehealth group. Approximately 83–85% of subjects from both groups who had complied with the first specialist referral complied with a second follow-up in-person specialist visit. Overall, 72.5% of subjects who had chosen a remote first specialist visit had entered into the continuum of care by the study end, vs. 25% of individuals in the in-person specialist group. A two-step approach that uses telehealth to overcome barriers may improve specialist referral compliance in LRMU individuals with increased OC risk.