Dataset Information

The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

ABSTRACT:

Background

With the COVID-19 pandemic came rapid uptake in virtual oncology care. During this, sociodemographic inequities in access to virtual visits (VVs) have become apparent. To better understand these issues, we conducted a qualitative study to describe the perceived usability and acceptability of VVs among Black adults diagnosed with cancer.

Methods

Adults who self-identified as Black and had a diagnosis of prostate, multiple myeloma, or head and neck cancer were recruited from 2 academic medical centers, and their community affiliates to participate in a semi-structured interview, regardless of prior VV experience. A patient and family advisory board was formed to inform all components of the study. Interviews were conducted between September 2, 2021 and February 23, 2022. Transcripts were organized topically, and themes and subthemes were determined through iterative and interpretive immersion/crystallization cycles.

Results

Of the 49 adults interviewed, 29 (59%) had participated in at least one VV. Three overarching themes were derived: (1) VVs felt comfortable and convenient in the right contexts; (2) the technology required for VVs with video presented new challenges, which were often resolved by an audio-only telephone call; and (3) participants reported preferring in-person visits, citing concerns regarding gaps in nonverbal communication, trusting providers, and distractions during VV.

Conclusion

While VVs were reported to be acceptable in specific circumstances, Black adults reported preferring in-person care, in part due to a perceived lack of interpersonal connectedness. Nonetheless, retaining reimbursement for audio-only options for VVs is essential to ensure equitable access for those with less technology savvy and/or limited device/internet capabilities.

SUBMITTER: Tam S

PROVIDER: S-EPMC10836309 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

Tam Samantha S Neslund-Dudas Christine C Barrett Amy M AM Barrow Lauren C J LCJ Fridman Ilona I Kinlaw Alan C AC Puviindran Praveen P Royce Trevor J TJ Smith Angela B AB Stein Jacob N JN Wood William A WA Elston Lafata Jennifer J

The oncologist 20240201 2

<h4>Background</h4>With the COVID-19 pandemic came rapid uptake in virtual oncology care. During this, sociodemographic inequities in access to virtual visits (VVs) have become apparent. To better understand these issues, we conducted a qualitative study to describe the perceived usability and acceptability of VVs among Black adults diagnosed with cancer.<h4>Methods</h4>Adults who self-identified as Black and had a diagnosis of prostate, multiple myeloma, or head and neck cancer were recruited f ...[more]

PMID: 37756655

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Project description:BackgroundHealth systems are rapidly promoting digital cancer care models to improve cancer care of their populations. However, there is growing evidence that digital cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantage, such as Black communities. Despite the increasing recognition that older Black adults face significant challenges in accessing and using health care services due to multiple socioeconomic and systemic factors, there is still limited evidence regarding how older Black adults' access and use digital cancer care.ObjectiveThis study aims to better understand the digital cancer care experience of older Black adults, their caregivers, and health care providers to identify strategies that can better support patient-centered digital cancer care.MethodsA total of 6 focus group interviews were conducted with older Black adults living with cancer, caregivers, and health care providers (N=55 participants) across 10 Canadian provinces. Focus group interviews were recorded and transcribed. Through a theory-informed thematic analysis approach, experienced qualitative researchers used the Patient Centered Care model and the synergies of oppression conceptual lens to inductively and deductively code interview transcripts in order to develop key themes that captured the digital cancer care experiences of older Black adults.ResultsIn total, 5 overarching themes describe the experience of older Black adults, caregivers, and health care providers in accessing and using digital cancer care: (1) barriers to access and participation in digital care services, (2) shifting caregivers' dynamics, (3) autonomy of choice and choosing based on the purpose of care, (4) digital accessibility, and (5) effective digital communication. We identify 8 barriers and 6 facilitators to optimal digital cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African or Caribbean languages, and patient concerns of shifting power dynamics when supported by their children for digital cancer care; and facilitators include community-based cancer support groups, caregiver support, and key features of digital technologies.ConclusionsThese findings revealed a multifaceted range of barriers and facilitators to digital cancer care for older Black adults. This means that a multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and usage of digital cancer care. A redesign of digital cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults, can enhance the digital care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers, or culturally sensitive training are important in responding to the complexity of access to digital l cancer care. These findings have implications for other structurally marginalized and underresourced communities that have suboptimal access and usage of digital care.

Project description:BackgroundNo-shows are a persistent and costly problem in all healthcare systems. Because forgetting is a common cause of no-shows, appointment reminders are widely used. However, qualitative research examining appointment reminders and how to improve them is lacking.ObjectiveTo understand how patients experience appointment reminders as part of intervention development for a pragmatic trial of enhanced appointment reminders.DesignQualitative content analysis PARTICIPANTS: Twenty-seven patients at a single Department of Veterans Affairs hospital and its satellite clinics APPROACH: We conducted five waves of interviews using rapid qualitative analysis, in each wave continuing to ask veterans about their experience of reminders. We double-coded all interviews, used deductive and inductive content analysis to identify themes, and selected quotations that exemplified three themes (limitations, strategies, recommendations).Key resultsInterviews showed four limitations on the usability of current appointment reminders which may contribute to no-shows: (1) excessive information within reminders; (2) frustrating telephone systems when calling in response to an appointment reminder; (3) missing or cryptic information about clinic logistics; and (4) reminder fatigue. Patients who were successful at keeping appointments often used specific strategies to optimize the usability of reminders, including (1) using a calendar; (2) heightening visibility; (3) piggybacking; and (4) combining strategies. Our recommendations to enhance reminders are as follows: (1) mix up their content and format; (2) keep them short and simple; (3) add a personal touch; (4) include specifics on clinic location and contact information; (5) time reminders based on the mode of delivery; and (6) hand over control of reminders to patients.ConclusionsAppointment reminders are vital to prevent no-shows, but their usability is not optimized for patients. There is potential for healthcare systems to modify several aspects of the content, timing, and delivery of appointment reminders to be more effective and patient-centered.

Project description:BackgroundAlthough videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses' ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.ObjectiveThis study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).MethodsIn this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.ResultsMost patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.ConclusionsPerson-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.International registered report identifier (irrid)RR2-10.2196/27940.

Project description:ImportanceRacial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing these inequities. However, qualitative evidence that highlights Black SLE care experiences is limited.ObjectiveTo identify opportunities for improving SLE care based on the experiences and perspectives of Black adults with SLE.Design, setting, and participantsIn this qualitative study, an interpretive description approach was used and data were analyzed using inductive thematic analysis. Semistructured interviews with Black adults in Michigan who were diagnosed with SLE were conducted. Interviews occurred from November 2, 2021, to July 19, 2022, and data analysis occurred from May 6, 2022, to April 12, 2023.Main outcomes and measuresDeidentified transcripts from the interviews were analyzed to develop themes that focused on opportunities to improve quality of care and symptom management.ResultsThe participants included 30 Black adults with SLE (97% women; mean age, 41 years; range, 18-65 years). Four main themes were identified: (1) awareness of SLE signs and symptoms before diagnosis (participants emphasized delays in diagnosis and how knowledge concerning SLE could be limited in their families and communities); (2) patient-clinician interactions (participants faced discrimination in health care settings and talked about the value of coordinated and supportive health care teams); (3) medication adherence and health effects (participants experienced a range of adverse effects from medications that treat SLE and described how monitoring medication use and efficacy could inform tailored care approaches); and (4) comprehensive care plans after diagnosis (participants reported persistent pain and other symptoms despite treatment). In the context of disease management, participants emphasized the importance of behavioral change and the negative impact of social risk factors.Conclusions and relevanceThe findings of this qualitative study suggest how limited information about SLE, experiences of racism, treatment regimens, and social risk factors may affect Black people with SLE. Future research should further engage and include Black communities within the context of treatment and intervention development to reduce racial inequities.

Dataset Information

The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

Background

Methods

Results

Conclusion

Publications

The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

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