Telemedicine Perspectives in Radiation Oncology

PURPOSE/OBJECTIVE(S): Given the changes to Radiation Oncology clinic workflow inspired by the COVID-19 pandemic, this study sought to determine the attitudes and perceptions of radiation oncologists towards the integration of telemedicine in the clinical setting. MATERIALS/METHODS: An online survey was sent nationwide to radiation oncologists, accompanied by a $10 gift card incentive for completing the survey. Of 117 complete responses received, the majority of respondents reported practicing in an academic setting (92%) and in an urban area (95%). 42% of respondents were still in training, while the rest had graduated from residency 0-5 years (16%), 6-10 years (8%), 11-20 years (15%), and 21+ years (19%) ago. RESULTS: Of all respondents, 79% worked at institutions that had implemented a work-from-home policy. Satisfaction was reported to be 87% regarding work-from-home flexibility, 84% regarding decreased commute to work, 40% regarding interaction with patients, 46% regarding impact on workflow, and 76% regarding overall impression. Before COVID-19, 99% of all visits were completed in-person whereas after COVID-19, telephone and telemedicine video visits comprised approximately 35% of new patient consults, 12% of on-treatment visits (OTVs), and 51% of follow-up visits. The primary factors in determining whether a patient was seen via telemedicine were patient preference (46%), physician preference (32%), and department policy (22%). Overall, in-person visits were felt to be better than telemedicine encounters in obtaining information during consultation (55%), establishing a personal connection with the patient/family (89%), answering questions about radiation treatment (45%), assessing for toxicity while on-treatment (87%), and assessing for toxicity/recurrence during follow-up (70%). 70% of respondents were in favor of more telemedicine utilization even after the COVID-19 pandemic, while 22% were in favor of telemedicine use only during the pandemic, and 8% were against the use of telemedicine unless absolutely necessary. Telemedicine visits for OTV encounters were deemed somewhat appropriate or extremely appropriate by 86% of respondents for patients confirmed to be COVID-positive, 79% for patients with mild symptoms who had not been tested, 65% for asymptomatic patients living with an at-risk person, 57% for asymptomatic patients who had recently traveled to a high-risk zone within the last 14 days, 92% for physician with mild symptoms who had not been tested, and 89% for asymptomatic physician living with an at-risk person. CONCLUSION: Telemedicine has become quickly integrated into the Radiation Oncology clinical workflow allowing for convenience, flexibility, and minimization of infection transmission. These encounters are likely to play a role in conjunction with – not in place of – in-person visits, which allow physicians the ability to obtain crucial information during consultation, establish a personal connection with patients, and assess for toxicity/recurrence.