JMIR Publications

ABSTRACT

Background:

Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Equitable patient engagement must be maintained as digital health solutions become increasingly prevalent.

Objective:

We aimed to characterize inequities in access and patient-reported experience at a tertiary cancer centre.

Methods:

We designed a cross-sectional study of outpatients with visits from September—December 2020. Four pairs of comparison groups were defined: 1) patients with VC and in-person visits, 2) patients with and without documented email addresses, 2) responders and non—responders to an email-based, patient-reported experience survey, and 3) responders with VC and in-person visits. Patient characteristics and completed surveys were collated. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMD), with SMD > 0.2 indicating a difference between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with p < 0.05 indicating statistical significance.

Results:

In total, 42,194 patients had outpatient visits, 62.7% had at least one VC visit, and 31.2% were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD < 0.2). Among emailable patients, 21.8% responded to the survey. Survey responsiveness was similar across demographic and socioeconomic indices, aside from a small difference by age (SMD = 0.24). Among responders, 24.4% received VC and were similar to in-person responders across demographic and socioeconomic indices (SMD < 0.2). Clinic types differed within each pair of comparison groups (SMD > 0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (p > 0.05). Regardless of visit type, patients had variable satisfaction with care domains across socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with cultural appropriateness of their care (OR 0.70, 95% CI: 0.57¬—0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI: 0.48—0.93), and those with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI: 0.68—0.97) and emotional (OR 0.86, 95% CI: 0.77—0.96) symptoms. Patients with higher RI scores were less satisfied with the duration of their visit (OR 0.85, 95% CI: 0.74—0.98, p = 0.024). Male patients were more satisfied with how their healthcare provider had listened to them (OR 1.64, 95% CI: 1.11—2.44, p = 0.014).

Conclusions:

VC and email can maintain equitable patient engagement in cancer care across demographics and socioeconomic indices. Targeted interventions are required to address existing health inequities among structurally marginalized patients.