Identifying Barriers to Being Offered and Accepting a Telehealth Visit for Cancer Care: Unpacking the Multi-Levels of Documented Racial Disparities in Telehealth Use.

Abstract

Objective: To evaluate patient- and area-level factors in relation to telehealth visit use in cancer care.

Study setting and design: We surveyed a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central North Carolina and one in southeast Michigan) and their community affiliates. Black adults and those with a scheduled telehealth visit were purposively oversampled during recruitment. We linked respondent residential addresses to area-level measures, including broadband access. The two patient-reported outcomes of interest were (1) whether a choice in visit type (virtual or in-person) was offered and (2) scheduled visit type.

Data sources and analytic sample: We assembled a cohort of 773 adults (response rate = 15%). After excluding nonrecall for being offered a choice, the analytic sample was 725 adults.

Principal findings: The sample was 46% aged < 65 years, 42% Black, and 67% women. Black respondents were less likely than non-Black respondents to be offered a choice, 15% versus 23%, prevalence difference (PD) and 95% CI = (-8.7%, CI: -14.4, -3.0) and if offered a choice, less likely to accept a telehealth visit (20% vs. 67%; PD = -47.0%, CI: -62.0, -32.0). Compared to men, women had a lower frequency of visit choice (16% vs. 27%; PD = -10.9%. CI: -17.4, -4.4) and accepted telehealth visits (42% vs. 63%; PD = -20.8%, CI: -36.8, -4.7). Respondents who expressed technology-related worries were less likely to accept a telehealth visit. Lower area-level technology access (e.g., broadband ownership) and higher poverty were nonsignificantly associated with less offering and less scheduling of telehealth visits.

Conclusions: Interventions to improve access to telehealth in cancer care and mitigate structural inequities (namely racism and sexism) should consider patient- and area-level barriers to being offered a choice in visit type and the ability to accept a telehealth visit.