JMIR Publications

ABSTRACT

Background:

Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized.

Objective:

This study examined how, for whom, and in what contexts VFU works for cancer survivorship care.

Methods:

We conducted a realist evaluation of VFU among breast cancer (BC) and prostate cancer (PC) patients at an urban cancer centre during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semi-structured interviews were conducted with a purposive sample of patients ≤5 years post-diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis.

Results:

Participants (n = 24; 12 BC, 12 PC) were on average 59.6 years-of-age (SD = 10.7). The majority (83.3%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient-centeredness. Whether VFU worked well for patients depended on patient factors (e.g., needs, psychosocial well-being, technological competence), provider factors (e.g., socioemotional behaviours, technological competence), and virtual care system factors (e.g., modality, functionality, usability, virtual process of care and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (e.g., satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider.

Conclusions:

Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient-centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs, enhancing physician online socioemotional behaviours and technology competency, and enhancing VFU functionality, usability, processes of care and communication workflows will improve patient perceptions of the patient-centeredness and effectiveness of virtual care.