In a recent review published in BJC reports, a group of authors assessed the opportunities and challenges brought on by the swift transition to virtual consultations (VC) in the United Kingdom (UK) cancer genetics services during the coronavirus disease 2019 (COVID-19) pandemic, promoting an integrated approach to optimize patient outcomes.
Study: The role of virtual consultations in cancer genetics: challenges and opportunities introduced by the COVID-19 pandemic. Image Credit: PopTika/Shutterstock.com
Background
The COVID-19 pandemic accelerated the UK's National Health Service (NHS) genetic services transition to VC.
The move was propelled by increasing waiting time for cancer care, worsened by the pandemic. Virtual care, tested before but implemented sporadically, aimed to prevent further delays in cancer genetics services.
Despite initial concerns, high patient satisfaction was observed. Pre-COVID, the NHS aimed for universal VC access by 2024. However, the pandemic-induced lockdown led to a rapid uptake of virtual platforms across NHS, funded by a £20,000 grant, fulfilling the aim earlier than planned.
Opportunities
Geographical inequalities
VC could help alleviate geographical inequalities in accessing cancer genetics services, particularly for rural patients. Travel costs and inconvenience to patients, often located far from these specialized centers, typically in metropolitan areas, can be significant.
Considering more households have internet access than cars, VC may be a more feasible alternative to distant, in-person appointments.
Economics and efficacy
A 2016 study in the Netherlands showed that virtual genetic counseling for cancer genetics appointments saved 7.6% time and 10.2% cost.
These savings were mainly due to reduced travel time. Additionally, the flexibility of virtual services could result in efficiencies in other areas, such as managing urgent work or accommodating self-isolating clinicians.
Meeting patient expectations
As technology becomes more integrated into daily life, patients may expect healthcare to adapt similarly. VC can help mitigate the financial impact of cancer treatment by reducing time off work or school.
They also offer the comfort, safety, and privacy of home, which is particularly beneficial for immunocompromised patients. Acceptance for virtual appointments has significantly increased post-COVID-19, with patients often appreciating the rapport built during virtual interactions with clinical genetics professionals.
Carbon footprint
Virtual healthcare models have been proven to lessen the carbon footprint by minimizing transport, aligning with the NHS's long-term carbon net zero plan to provide care at or near home.
Family approach
VCs can enable a family-centric approach to genetic testing by allowing relatives to participate in sessions from disparate locations.
Platforms like Attend Anywhere merge VCs, enabling family counseling irrespective of geographical boundaries.
While privacy and confidentiality must be upheld and appropriateness considered, this capacity to connect family members can prove beneficial under certain circumstances.
Challenges
VC to genetics services
The 2019 UK Consumer Digital Index found 22% of the population lacks the necessary digital skills. This proportion is projected to shrink to 8% by 2030 but may impede virtual healthcare access among disadvantaged groups.
Digital literacy relies on internet access, skills, confidence, and motivation. About one in four patients have reported technical issues during VC.
Therefore, while virtual care may ease geographical constraints, patient collaboration is necessary to minimize digital barriers, suggesting a need for a mixed approach of physical and virtual appointments.
Digital literacy among clinicians
Clinicians, like patients, exhibit varying degrees of digital literacy. While some find VC helpful for visually explaining genetic concepts, others might feel limited by the format.
The NHS has been slow in adopting digital technology, often using outdated hardware and software, and unreliable internet connections can disrupt consultations. Over half of the genetic counselors reported technical issues during VC.
Therefore, providing adequate information technology (IT) resources and infrastructure is essential.
Regular updates to data handling procedures must ensure legislative and guideline compliance. Many current platforms were designed for videoconferencing rather than medical consultations, so services must assess their chosen platforms' limitations and consider alternatives if necessary.
Clinical examination
VC limits the clinician's ability to conduct physical examinations, sometimes required in cancer genetics services for detecting physical manifestations of predisposition syndromes. While self-measurements or emailed photographs can provide some information, an in-person assessment may be necessary for certain cases.
Triage and clinical discretion can determine which cases are suitable for VC. Secure integration of patient-submitted photographs via mobile apps, as used in dermatology, may offer further possibilities.
Coercion and confidentiality
In telehealth consultations, clinicians must navigate the patient's environment, which can impact confidentiality and cause distractions or coercions.
A patient's setting, such as a busy workplace or home with others present, can inhibit open communication and decision-making.
Clinicians need to remain aware of these surroundings and ensure that information isn't accidentally shared with third parties present in the room.
Digital counseling
Delivering sensitive news digitally can limit empathetic responses, affecting patient and provider experiences. Some may prefer receiving such information at home, surrounded by their support system. However, conveying empathy virtually presents challenges.
A study indicated no significant difference in anxiety and depression reduction after in-person or video genetic counseling, implying that virtual platforms may not inherently hinder empathy or emotional outcomes.
The decision for subsequent appointments should be a collaboration, allowing for provider discretion and patient preference.
Telephone versus video consultations
Phone and video calls are both used for virtual doctor visits. Sometimes, tech problems can make video calls turn into phone calls.
In a phone call, the doctor can't see the patient's body language. Studies show that patients feel the same amount of comfort and understanding in both types of calls.
Even though video calls might be better for doctors, some patients prefer phone calls because they are easier to use. The use of new tech, like chat robots, is growing, which can be both good and bad.
Workload management
Managing the workload in VC is vital. Flexibility in appointments can be beneficial but may also lead to issues, requiring clear patient information to manage expectations.
Ensuring clinicians' balanced workload is critical and shouldn't be increased due to saved travel time. Studies suggest flexible scheduling doesn't increase professional burnout and reduces work-related stress.
Additionally, online training tools developed during lockdowns may help in workload management when accessed remotely.
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