Safety and Satisfaction of Patients Opting for Fully Remote Consultation and On-Treatment Management Visits During COVID-19

PURPOSE/OBJECTIVE(S): We have previously demonstrated high patient satisfaction with telemedicine during the COVID-19 pandemic. During the relaxation of pandemic restrictions, patients are now offered a choice of in person or remote visits. Here we report on the experience of a cohort of patients treated with radiotherapy who opted for fully remote providers. MATERIALS/METHODS: At the time of new visit consultation scheduling, patients were offered fully remote management if availability of onsite providers was limited. Additionally, after initial consultation with the treating oncologist, if patients expressed preference for treatment at a regional facility different from the oncologist's primary site, they were offered treatment at the preferred site with fully remote on-treatment visits, without transfer of care to an onsite provider. Potentially harmful patient safety events and “near-misses” were prospectively collected with an in-house quality improvement reporting system. Patient satisfaction surveys assessing several domains of the patient experience (including appointment logistics, patient-physician communication, and overall impressions) were distributed to patients before, during and after treatment. RESULTS: From 10/2020 to 2/2021, a total of 192 patients treated to 208 sites opted for fully remote management. 50% were male, 50% female. 61% of patients had metastatic disease. Sites treated included prostate (10%), breast (7%), thoracic (7%), head and neck (2%), gastrointestinal (25%), and other sites including bone, soft tissue and brain (49%). There were 46 minor (no harm or near-miss) patient safety events reported, of which 85% were unrelated to patient condition or physician communication and included events associated with treatment planning, orders, prescriptions and delivery. Minor events related to patient condition and patient scheduling/communication comprised 9% and 6% of events, respectively. There was 1 temporary harm event of patient decompensation in the department requiring activation of emergency services. The safety event rate per patient was similar between this cohort and non-remotely managed patients treated during the same period. The telemedicine survey response rate was 32%. Patient satisfaction with telehealth visits remained high with 98% of experiences across all domains rated as Good to Very Good. 90% of patients either preferred telehealth or expressed no preference with the in person vs. fully remote visits. CONCLUSION: Treatment with fully remote providers is safe and feasible, with no serious patient events and minimal need for onsite care. We observed high patient satisfaction, consistent with our previously reported outcomes for telemedicine visits. These findings support the continuation of fully remote management for select patients in the post-COVID era, which can only continue if the current remote/telehealth exemption is continued beyond the emergency period.