Trends and Disparities in Telehealth Utilization for Cancer Care during COVID-19

PURPOSE/OBJECTIVE(S): COVID-19 has dramatically increased telehealth utilization for cancer care delivery. However, telehealth access and utilization may differ amongst minority populations. We evaluated differences in telehealth utilization and patient satisfaction based on patient demographics. MATERIALS/METHODS: Anonymized patient surveys from all virtual visit (VV) and in-person visits (IP) collected between April 2020 - January 2022 at a single comprehensive cancer center were included. Available patient demographic data included age, gender, race/ethnicity, language, and marital status. Patient demographics for virtual visits were compared to in-person visits using Wilcoxon rank-sum, chi-square, or Fisher's exact test as appropriate. Patient satisfaction surveys consisted of 10 closed-end questions assessing the following aspects of the patient experience: connection quality (2/12), patient-physician communication (6/12), and overall provider quality (2/12. Qualitative responses were given on a 1-3 Likert-type scale ranging from no, yes (somewhat), and yes (definitely). Responses were binned into satisfied (yes, [definitely] responses) and not satisfied (no and yes [somewhat] responses). Univariate and multivariate analyses of patient satisfaction questions were carried out with a logic regression model with a significance level of 0.05. RESULTS: In total, 3424 VV and 17303 IP surveys were assessed. Compared to IP, VV had significantly less utilization amongst Asian (6% vs. 9%, p<0.01) and Hispanic patients (6% vs. 9%, p<0.01), but similar utilization for White (71% vs. 66%, NS), Black (10% vs 9%, NS), and other (5% vs 5%, NS) patients. VV had significantly fewer non-English speaking patients compared to IP (3% vs. 6%, p<0.01). There were no significant differences in patient satisfaction scores based on race/ethnicity for White, Asian, or Black patients. Hispanics were more likely to be satisfied compared to White, Black, and Asian patients regarding connection ease (OR 3.4, p<0.01), connection quality (OR 2.18, p<0.01), quality of explanation (OR 2.85, p<0.01), appointment timing (OR 2.63, p<0.01), and follow-up instructions (OR 1.75, p=0.03). English-speaking patients were significantly more than non-English speaking patients regarding connection quality (OR 1.68, p=0.03), patient-provider trust (OR 1.87, p=0.04), and overall rating (OR 1.77, p=0.05). There was a significant decrease in VV utilization compared to IP over time as the pandemic progressed (p<0.01). Compared to White patients, Asian (p<0.01) and Black (p=0.04) patients saw a larger decrease in VV utilization over time. CONCLUSION: Virtual compared to in-person visits were less likely to be utilized by Asian, Hispanic, and non-English speaking patients. Hispanic patients were more likely to be satisfied with their virtual visit, while non-English speaking patients were less likely to be satisfied. Further research is needed to understand the reason for disparities in telehealth utilization.