Published on September 23, 2021
Support Is Needed to Ensure Patient Access to Telemedicine
In early September, the Prostate Health Education Network (PHEN) explored “The Impact of COVID-19 on the Prostate Cancer Racial Disparity” during the first session of their 17th Annual African American Prostate Cancer Disparity Summit. While experts believe that genetics contribute to prostate cancer disparities for Black men, barriers in access to medical care, health insurance, and early detection also play a role. Doctors and patients came together at the PHEN summit to discuss COVID-19 and how the increase in telemedicine is impacting the prostate cancer racial disparity.
The Increase in Telemedicine During COVID-19
While the coronavirus pandemic disrupted some aspects of cancer care, including delaying screenings and treatments, it also led to the use of new technologies. As healthcare providers explored ways to care for their patients while adapting to social distancing guidelines, COVID-19 pushed telemedicine into the spotlight.
“The COVID-19 pandemic changed everything,” said Daniela Wittman, PhD, MSW, a psychotherapist and researcher from the University of Michigan in Ann Arbor. “It removed a lot of the regulations that governed telemedicine so patients could connect from home to their healthcare providers and providers were allowed to practice across state lines.”
The pandemic inspired changes to other regulations: coverage for virtual healthcare services expanded, so telehealth could be reimbursed as an office visit; many patients were able to have telehealth copayments waived; and privacy rules were relaxed to allow patients and providers to connect using the most widely available technology, including telephone calls, Facetime, and Zoom. Time will tell which of these changes will endure; some telehealth rule changes have already been rolled back.
Regardless, COVID-19 forced healthcare providers to upgrade their technology and resources to handle the explosion in virtual visits, something they may have postponed had the pandemic not necessitated it, Dr. Wittman explained. She and her colleagues at the University of Michigan started canceling surgeries and in-person appointments in March 2020 and moved everything they could to telehealth.
“The system was not ready for it,” she said, “so we were constantly crashing the system. Upscaling our ability to provide telehealth visits was a very big challenge. [COVID-19] was hugely influential because all of a sudden, everything that was happening in person… was happening via video and telephone.”
Dr. Wittman shared a University of Michigan study that showed that the frequency of telehealth visits spiked in March 2020 and then leveled out, but they have not returned to the lower pre-pandemic levels.
“Before the pandemic, there were very few telehealth visits,” she said. “We were doing them, but very, very little. It looks like telehealth visits are here to stay.”
Prostate Cancer Can Be Managed via Telemedicine
Citing a 2020 study of the effectiveness of video visits as a substitute for urological clinic visits, Dr. Wittman explained why telehealth visits are becoming widely accepted for treating prostate cancer.
“What we have found in oncology is that with the exception of surgery for prostate cancer, MRIs, biopsies, and blood tests, most of the clinic visits could be done in video form. Even consultations to make decisions about treatment, certain follow-ups, and our survivorship clinics have all been done in video format. There are clear possibilities for introducing telemedicine into prostate cancer care,” she said.
While Dr. Wittman said that telemedicine can help treat and manage prostate cancer, she also noted that structural issues can prevent patients from getting care. Lack of access to broadband internet and devices that support video calls, for example, may limit its use. She also acknowledged that patient habits and preferences will influence adoption rates.
Some Patients and Providers Have Concerns About Telemedicine
Telehealth visits may be here to stay, but not everyone is ready to adopt this low-touch form of healthcare. Azell Martin, a 13-year prostate cancer survivor from Boston, expressed his concerns. “There are some parts of telemedicine I’m not agreeable with,” said Martin. “My primary care doctor said that he wanted to have a telemedicine [visit] with me, and I said, ‘You’re not taking my temperature. I’m not getting a blood test. I’m not getting anything but conversation.’ I asked him, ‘Am I going to have to pay a copay?’ He said yes.”
Martin said patients shouldn’t have to pay for a visit if they aren’t getting what he considers a complete examination, one that includes a physical exam, vital signs, and an in-person conversation about side effects from treatment and medication. He also said he suspects doctors will miss things they may have picked up on in person, like new or changing bruises and other side effects and symptoms.
Robert Waterhouse Jr., MD, MBA, a urologist from Carolinas Medical Center in Charlotte, North Carolina, also voiced concerns: “When it comes to telehealth, from my perspective, it raises more questions than answers. I am concerned about the effectiveness of [virtual] visits. Are they really adequate to drive the same kind of shared decision-making that’s important to have with something like prostate cancer? [This disease] has multiple implications – everything from active surveillance to very aggressive interventions. I think that’s an unanswered question.”
Dr. Waterhouse said he was concerned about providers being able to pick up on non-verbal cues that might not be as detectable during a virtual visit. He also expressed concerns about providers being able to communicate effectively with patients of other cultures than their own through a video call. He said he wonders if having a screen between patient and provider will increase disparities in how care is provided to members of different racial and ethnic groups. However, he also noted the potential benefits of telemedicine, like the ability for clinicians to collaborate with other experts who are not on-site.
“At the same time that there are challenges, there are also opportunities,” he said. “I think because virtual visits are here to stay, we need to think about them from an innovative approach… how to make them better so they can become some of the resolutions for driving better health equity.”
Healthcare Providers Play an Important Role in Patient Education
Some experts think it is the responsibility of healthcare providers to address patient concerns about telemedicine through education. “African American men are less likely to participate in telemedicine, but prostate cancer can be cared for by telemedicine,” said Keith Crawford, MD, PhD, Director of Clinical Trials and Patient Education for PHEN. “So, it becomes our responsibility to educate the patient, just like we educate about screening, treatment options, and clinical trials. Telemedicine will be another one of our agenda items as we move forward.”
Dr. Wittman agreed, noting that while telehealth can be a bridge for many people, healthcare providers must also understand that patients need to be taught how to use it. She said that cancer organizations like the American Cancer Society and cancer centers should provide training for people on how to use telehealth, alleviate their concerns about it, and help them feel more comfortable using it.
“I think the takeaway here is that telehealth, like all healthcare, is a resource and, potentially, culture-driven,” said Dr. Wittman. “It’s important for people to be able to have broadband, they have to have the devices and know how to use them, they have to be confident that insurance will pay for telehealth visits, and they have to feel that it’s a medium that can be trusted.”
For more information about PHEN or to register for an upcoming session, visit phensummit.org.
See Our Sources:
- Prostate Health Education Network (2021). “The Impact of COVID-19 on the Prostate Cancer Racial Disparity.”
- American Cancer Society (2019). “Cancer Facts & Figures for African Americans | 2019 - 2021.”
- University of Michigan Institute for Healthcare Policy and Innovation (2021). “Telehealth Research Incubator Research Snapshots.”
- Urology (2020). “Video Visits as a Substitute for Urological Clinic Visits.”