Enhanced Telehealth in Prostate Cancer.
Enhanced telehealth for prostate cancer patients showed high feasibility and patient satisfaction, with completion rates exceeding 60% for all services offered.
Where it sits
this study against the rest of the degarelix corpusSummary and findings
This study assessed the feasibility of enhanced telehealth for patients with prostate cancer receiving androgen deprivation therapy. A total of 38 patients were enrolled, and various components of telehealth were evaluated over an 8-month period. Completion rates for services such as remote blood pressure monitoring and home phlebotomy were reported.
Abstract
<h4>Importance</h4>Prostate cancer often requires frequent in-person clinical visits, imposing substantial travel, financial, and time burdens for patients. Combining telehealth with in-home monitoring (enhanced telehealth) has the potential to make care more patient centered and efficient.<h4>Objective</h4>To assess the feasibility and implementation context of enhanced telehealth for patients with prostate cancer.<h4>Design, setting, and participants</h4>Adult patients with prostate cancer receiving androgen deprivation therapy (ADT) were enrolled in this multiphase quality improvement study of enhanced telehealth from June 1, 2023, to June 30, 2024, and followed up for 8 months. The study was conducted at 7 ambulatory oncology practice sites at Memorial Sloan Kettering, an academic comprehensive cancer center. Phase 1 included semistructured interviews with key stakeholders to assess implementation considerations of enhanced telehealth. Phase 2 piloted an enhanced telehealth program offering remote blood pressure (BP) monitoring, mobile phlebotomy, and injections at home; patients could choose to participate in any available component.<h4>Intervention</h4>Enhanced telehealth, a care delivery model that augments routine telehealth encounters with (1) home phlebotomy, (2) remote BP monitoring, and/or (3) at-home administration of ADT or other injectable therapies.<h4>Main outcome and measures</h4>The primary outcome was feasibility, assessed by completion rates for each enhanced telehealth component at the patient and visit levels. Patient and clinician satisfaction was assessed using the Net Promotor Score. Acceptability, appropriateness, and feasibility were measured using validated measures on a 5-point Likert scale.<h4>Results</h4>Thirty-eight patients participated; the median age was 70.0 years (IQR, 61.5-76.7 years) and 24 (63.2%) had metastatic castration-sensitive prostate cancer. Patient-level completion rates for at least 1 service were telehealth, 68.4% (26 of 38); remote BP monitoring, 91.9% (34 of 37); home phlebotomy, 96.3% (26 of 27); and at-home injections, 90.0% (9 of 10). Visit-level completion rates were high for telehealth (92.3% [60 of 65]), phlebotomy (95.4% [145 of 152]), and injections (84.6% [11 of 13]) but lower for BP monitoring (65.0% [343 of 528]). Patients rated all components as acceptable (mean [SD] score, 4.8 [0.4]; range, 3.25-5), appropriate (mean [SD] score, 4.8 [0.4]; range, 3.75-5), and feasible (mean [SD] score, 4.7 [0.5]; range, 3.25-5). Enhanced telehealth had high patient and clinician satisfaction (Net Promotor Score: patients, 82.4%; clinicians, 80.0% for telehealth, 80.6% for remote BP monitoring, 84.6% for home phlebotomy, and 75.0% for home injections).<h4>Conclusions and relevance</h4>In this quality improvement study, enhanced telehealth was feasible, with greater than 60% completion for all scheduled visits, with strong endorsement of benefits from patients with prostate cancer as well as clinicians. These findings support further development of enhanced telehealth.
Background
This paper addresses the clinical question of how enhanced telehealth can reduce the burden of frequent in-person visits for prostate cancer patients. Prior studies have indicated that telehealth can improve patient access and satisfaction, but the specific feasibility of enhanced telehealth in this population was not well established. Understanding the implementation context and patient experiences with enhanced telehealth is crucial for future development.
Methods
This multiphase quality improvement study enrolled adult patients with prostate cancer receiving androgen deprivation therapy from June 1, 2023, to June 30, 2024, with an 8-month follow-up. The study was conducted at 7 ambulatory oncology practice sites. Phase 1 involved semistructured interviews, while Phase 2 piloted an enhanced telehealth program that included remote blood pressure monitoring, mobile phlebotomy, and at-home injections.
Results
The primary outcome was feasibility, with patient-level completion rates reported as follows: telehealth 68.4% (26 of 38), remote BP monitoring 91.9% (34 of 37), home phlebotomy 96.3% (26 of 27), and at-home injections 90.0% (9 of 10). Visit-level completion rates were high for telehealth (92.3% [60 of 65]), phlebotomy (95.4% [145 of 152]), and injections (84.6% [11 of 13]), but lower for BP monitoring (65.0% [343 of 528]). Patient satisfaction was high, with a mean score of 4.8 on a 5-point Likert scale.
Interpretation
The findings suggest that enhanced telehealth is feasible for prostate cancer patients, with high completion rates for most components. While the statistical significance of these findings is evident, the clinical significance may be limited by the small sample size and single-site nature of the study. Further research is needed to validate these results across diverse populations and settings.
Key findings
- Patient-level completion rates for telehealth were 68.4% (26 of 38).
- Remote BP monitoring completion rate was 91.9% (34 of 37).
- Home phlebotomy completion rate was 96.3% (26 of 27).
- At-home injections completion rate was 90.0% (9 of 10).
- Visit-level completion rates for telehealth were 92.3% (60 of 65).
- Net Promotor Score for patients was 82.4%.
Limitations
- small sample size of 38 patients
- single-site study limits generalizability
- no long-term follow-up reported
- potential selection bias in participant enrollment