Development of psycho-oncology telehealth guidelines: a modified Delphi consensus study

Abstract

In response to COVID-19, psycho-oncology clinicians moved to a model of telephone and videoconference treatment in Australia. The Psycho-oncology Co-operative Research Group (PoCoG) identified a paucity of evidence available to guide adaptation of therapy for remote delivery. This research aimed to develop consensus for evidence-based guidelines on ways to adapt psychological therapies in psycho-oncology for remote delivery. A national expert advisory group (N = 11) was convened consisting of psycho-oncology clinicians and clinical researchers. An iterative codesign methodology was used to draft psycho-oncology telehealth guidelines. Australian psycho-oncology clinicians participated in a Delphi consensus process to guide the content included in the guidelines. Content was presented under six domains: (i) screening and outcome measures, (ii) formulation, (iii) safety considerations, (iv) resource adaptation, (v) adaptations to therapy, and (vi) example case studies. Participants rated items based on importance, therapeutic appropriateness, and/or usefulness. Consensus was defined as >80% agreement. Thirty-two psycho-oncology clinicians with telehealth experience participated in three Delphi rounds. Agreement was reached on (i) the importance of including screening and outcome measures (90%) and items (n = 5) related to how best to facilitate this; (ii) the importance of addressing provision of a formulation (100%), although only 2/6 strategies presented to facilitate formulation reached consensus; (iii) the appropriateness of proposed risk assessment and management strategies (84%); (iv) therapeutic appropriateness of simplifying resources (100%), including 3/5 visual optimization strategies; and (v) common behavioral components of therapy (n=5). Providing guidance to psycho-oncology clinicians for integrating telehealth into routine clinical practice must go beyond logistical considerations. These consensus-based guidelines provide support to clinicians for adaptation of psycho-oncology therapy to telehealth and will ensure evidence-based practice.