Optimal Utilization of Telehealth to Enhance Patient Care and Clinical Trial Participation

Telehealth has supplemented clinical care, and it helped overcome the barrier to clinical research during the COVID-19 pandemic.

Matthew A. Lunning, DO, FACP, Associate Professor, Fred & Pamela Buffett Cancer Center, Associate Vice-Chair of Research Department of Medicine, Assistant Vice Chancellor of Clinical Research, University of Nebraska Medical Center, Omaha, Nebraska, spoke on “Optimal Utilization of Telehealth to Enhance Patient Care and Clinical Trial Participation” as the final presentation of the 2022 Oncology Clinical Pathways Congress.

Even before COVID-19, telehealth was impactful across all sorts of diseases including depression, pain management, chronic respiratory failure, congestive heart failure, and end-of-life care.

“[End-of-life care] is something I think we do quite poorly unless you have a good team approach,” Dr Lunning said.

Dr Lunning found a study on palliative care and all the resources that are necessary for quality end-of-life care. Much of the time, patients with leukemia or lymphoma remain in the hospital for end-of-life care. It is not ideal, nor is it desirable, for the hospital, the patient, and the patient’s family. So why do they get their end-of-life care in the hospital setting?

“Because we do not have confidence that they can receive the level of care outside the hospital that they need,” Dr Lunning said. “So how do you build confidence with the family that they can do this at home?”

To start, face-to-face interaction helped improve confidence. Telehealth allowed patients to see their physicians and allowed physicians to see any physical symptoms even when they were not in the same room.

The US Department of Veterans Affairs is ahead of the game in this respect. They passed out iPads across the country. Low uptake and other barriers, such as difficulty of use, was expected from the veterans. Instead, the veterans loved using iPads to make virtual calls.

“They have taken the lead in approaching the virtual environment for their veterans … for our veterans,” Dr Lunning said.

Telehealth truly came to the forefront as the COVID-19 pandemic spread. The guidelines in April 2020 that restricted face-to-face contact jumpstarted the new era of telehealth. Using the paradigm set up several years earlier in dealing with Ebola, Dr Lunning’s practice set up similar guidelines.

“In April, we had a pandemic restriction plan stating that you weren’t coming to work unless you were an essential worker,” he said. “So now everything flipped upside down, now telehealth, your patient portal is like, anybody who isn’t getting chemotherapy, tell them to stay home.”

In the aftermath, the slow return to normalcy and reopening of care centers had challenges and precautions, including difficulties with laws and rules around whether electronic consent is equivalent to a written signature. Studies have shown that patients want to use electronic consent—overall preference for using a computer (65%) was far greater than paper (25%)—but the rate-limiting step is time. The proper time is required for patients to understand a trial. As recently as 1989, consent forms averaged less than 1,000 words. By 2010, the average consent form was about 4,000-words long.

“We’re trying to make patients more informed, but are we really doing that?” Dr Lunning asked.

In March 2020, with the COVID-19 pandemic beginning, Dr Lunning wrote a consent for a human biologic material protocol. He contacted patients via telehealth and sent them consent forms via email. It provided the potential participants with the time needed to understand the information.

“It was gold,” he said. “We accrued hundreds of patients, so that the next time they came in for a blood draw for clinical purposes, we grabbed their baseline blood. That was incredibly important because on the coast—where the pandemic spread earlier and more quickly—they had a lot of samples, but they didn’t have baseline data off the immune system of the patients who got COVID.”

While barriers still exist, particularly with FDA-regulated or DHHS-funded research, telehealth is proving to be an effective method in health care and could be used in clinical trials. One of its strengths is that it retains the face-to-face interaction between patients and clinicians while removing the inherent risk of potential exposure that comes with researching highly communicable pathogens.

“I think we really need to press that telehealth or electronic methods are necessary and would increase clinical trial participation and diversity within clinical trials,” Dr Lunning concluded.