Significant healthcare delivery adjustments across specialties have been necessitated by the COVID-19 pandemic, particularly within the breast cancer setting.
To decrease hospital infection risk and unnecessary foot traffic, consultations for some patients within 3 months of completing hospital treatment have been conducted by telephone rather than face-to-face, particularly at the end of treatment. These discussions are time-dependent and comprise elements such as the treatment summary and cancer care review, holistic assessment, care planning, and designating survivorship support services. Based on the extenuating circumstances of the COVID-19 pandemic, there was robust justification for adopting a telephone consultation format, especially for possibly immunocompromised patients. However, clinicians were acutely aware that consultation quality may be compromised when using a telephone format. A mixed-methods survey was initiated to evaluate patient satisfaction with a telephone consultation format and to ascertain whether a permanent modification was warranted.
Telephone consultations are well-established tools in medical practices. Some research has demonstrated that patients are equally satisfied with live face-to-face and telephone consultations1; however, there is a lack of consensus regarding their relative efficacy, based on the current body of evidence. The primary challenge with clinical visits conducted via telephone is maintaining understandable, unambiguous, and effective communication. There are inherent challenges when relying on telephonic communications, including the inability to assess nonverbal signals.1 Furthermore, having the ability to perceive emotional tone through a patient’s voice requires a specific skill set, for which clinical staff receive limited training.2 However, telephone consultations are clearly beneficial from an infection control perspective. For both healthcare providers and patients, telephone consultations may confer an array of benefits, including cost-effectiveness and convenience.3
During the pandemic lockdown, 62 patients who were scheduled for an end-of-treatment consultation were informed their appointment would be conducted by telephone rather than in person. Breast care nurses and cancer support workers conducted these telephone appointments. Half of the patients (N = 31) were randomly assigned to the study. While 1 patient declined participation, 30 patients provided verbal consent and completed a 12-point telephone questionnaire handled by medical students who were temporarily assigned during the COVID-19 response.
The study included patients who varied in age, treatments, and prognoses. The mean patient age was 61.5 years (range, 37-86 years). Eleven patients were <60 years of age, 10 were in their 60s, and 9 were ≥70 years of age. All patients had undergone breast surgery, and some had received adjunctive therapy (eg, chemotherapy, radiotherapy, or hormone therapy). Seven patients had ductal carcinoma in situ. For the 23 patients with invasive breast cancer, the Nottingham prognostic index was used to determine prognosis following surgery; patient scores were excellent (N = 2), good (N = 10), moderate (N = 7), and poor (N = 4).
A 10-point scale was used to assess patient satisfaction. For the telephone format, mean satisfaction scores were calculated and 90% of participants rated their satisfaction as ≥8, of which 59% scored it as 10. The consultation itself obtained a mean satisfaction score of 9.5, with 60% of patients scoring it as 10 and with no scores lower than 7.
Patients reported feeling free to speak and ask questions, and felt they had sufficient time. The vast majority (93%) reported that their concerns and questions were addressed completely (87%) or mostly (6%). While some patients (17%) reported that they would have preferred communicating with a doctor rather than a nurse, this was based on the perception that doctors possessed “better knowledge” or “more assurance”; this preference was not correlated with age.
A clinical examination was perceived as being necessary by 23% of patients, 43% of whom wanted inspection of surgical wounds, 13% desired to have another symptom assessed, and 72% wanted reassurance or peace of mind. Preference for a live, in-person consultation was selected by half of the patients (5 of whom also would have been happy with a telephone consultation), including 37% of patients aged >60 years and 73% of patients aged <60 years, suggesting that this preference was dependent on age.
Two-thirds of patients who preferred an in-person consultation (N = 10) felt that their choice was based on communication benefits, including improved explanations, more personal conversations, and nonverbal cues. Some patients (N = 3) believed it was more reassuring to have a live face-to-face consultation. Patients (N = 15) who preferred the telephone consultation format cited convenience (N = 6; 40%) and comfort (N = 4; 27%) as rationales. Two of these patients said they would have had a preference for face-to-face consultation if they had been anxious or encountered a problem.
The findings from this study are consistent with current evidence, which highlights the need to balance communication and practicality. The researchers expected older patients to favor more traditional face-to-face appointments, yet they were generally more willing to sacrifice in-person communication benefits by staying at home. It should be noted that this proposed scheduling occurred during a peak period of the coronavirus pandemic.4
Government guidelines and the COVID-19 threat likely played a role in older patients’ opinions about face-to-face meetings. The investigators suggested that younger patients may have had greater concerns about their diagnosis than COVID-19 risk, and this was likely a contributing factor in their preference for face-to-face discussion.
It should be noted that this research reflects patients’ perspectives and opinions at the time of lockdown. Before service provisions are modified, it is necessary to consider clinician views, time, cost-effectiveness, as well as the impact of the pandemic. Video consultations may confer benefits over telephone consultations but may require additional resources and incur logistical challenges.
The researchers concluded that during the COVID-19 pandemic, patients expressed satisfaction with their experiences with nurse-led telephone end-of-treatment follow-up consultations, but at least half of the patients would nevertheless choose an in-person session and a minority would favor a consult with a doctor.
Schuster-Bruce AT, Middleton HAR, Macpherson C, et al. Patient satisfaction with nurse-led end of treatment telephone consultation for breast cancer during COVID-19 pandemic. Breast J. 2021;27:77-79.
To sign up for our newsletter or print publications, please enter your contact information below.
