Table 4

Patient-preferred circumstances for in-person or telehealth

Subtheme	Quotations
Initial consults in-person	I think some, that initial establishment is, that connection is probably better made if you have your first visit in person…to kind of put you in an appropriate state of mind for the virtual visits (P-005-IPV). It was exceedingly valuable to meet my team face-to-face. The reason I say that is, is because, particularly in a palliative care setting, you’re establishing a relationship with the team (P-011-IPV). You get a whole sense of their level of compassion, of their level of commitment, and two different things completely. I would say that I was very glad that I had met my palliative care doctor personally and then switched to video because I had a, like a sense of what the palliative care doctor was like as a doctor as well as like a person… I think it makes a difference meeting that person first and then moving to video (P-016-IPV). The first time that I spoke to somebody it would have been nice to speak to them in person especially in that kind of a department (P-V1-VO).
In-person if a physical exam is necessary	Just looking and assessing the physical condition of the patient. I mean they did all my vitals, they weighed me, they looked at me and did a physical examination. All of those things are clearly either impossible or difficult to do, certainly over the telephone, I imagine even by video, there’s certain limitations for that (P-011-IPV).
In-person if there is a change in health status	If I feel like perhaps my own physicality or overall sort of energy is perhaps deteriorating, I’d probably want the doctor to sort of see me as like an entire person rather than just a flat paper screen (P-005-IPV). Maybe if there was a more definitive change in my health… Maybe I went from being stable and all of a sudden I turn and basically things are going to get worse and I need to understand what my options are. I would probably want a one-on-one rather than trying to do it over the telephone (P-009-IPV). But like once I start perhaps going down slowly or step or however this may work, I might require more hand-holding, figuratively or literally… (P-V10-VO).
In-person for discussion of sensitive information	If I were to get some not such great news from the oncology side, I’d want to speak to somebody. I’d want to see them [palliative care physician). I guess to help me cope with whatever’s going on (P-008-IPV). Anytime that there’s sensitive or maybe troubling information to be passed along by the doctor, that there’s a lot more opportunity for more of an empathetic discussion in house, in person than, than on the phone, and I, I believe it would probably be best to, to meet in person in a situation like that (P-013-IPV). I think people should meet in person, especially when they’re discussing difficult subjects, you know, like dying. So over the phone is, it’s not the place to do that (P-V1-VO). Like ten years ago when I was first diagnosed, I was frantic. Like I just this is a shot out of the blue. What do you mean I have advanced cancer? Like the total shock and, you know. Like I went through it all. And that wouldn’t have been good to have done that by phone or even MS Teams wouldn’t have been the greatest, uh, here. But if you’re conveying like particularly bad news I think the more empathy that you can convey, assuming there’s not a pandemic going around, that’s better to be done maybe a bit of a family call, for instance… (P-V10-VO).
Occasional mandatory in-person visits	But that most of the time, or even two months can pass, and then let’s say during that time could be a phone visit or something. But there should be a physical visit. Just to feel that there are things that you can describe on the phone, but there are other things that you’ll need to be there. You need a doctor to be looking at what you’re talking about (P-003-IPV). Maybe it’s once a year it can be an in-person, but I mean, you might notice something about me that I hadn’t noticed… And I might have, you might, want to observe me or something like that (P-007-IPV). My only suggestion, as I mentioned it before, is to give patients that option and even if they always choose over the phone, that they should be expected to come in every so often (P-V1-VO).
In person if either the physician or patient feels it is necessary	If phone visits are at the option of both the doctor and the patient, the doctor would say, ‘Well, a phone visit is, is appropriate.’ If the patient says, ‘Well, I’d like to see you in person,’ then you can do that. And if the doctor said, ‘No, I want to see you in person, you know, see how you’re doing, your weight etc., whatever,’ then we can do that (P-002-IPV). Quite often a palliative care physician will pick up on something, see something, hear something nonverbal… based on the physician. I mean this, it’s obviously up to the physician to lead to a certain degree in, in the relationship and make the suggestions that are most sensible. I think most patients are, they take what their physicians say or suggest quite seriously and give it some thought (P-011-IPV).
Virtual for periods of health stability	For me to go into his office, it doesn’t make any sense because I’m not having any changes going on at the moment (P-001-IPV). I mean, I’m relatively stable, whereas I guess a lot of people aren’t and they would all want to meet you in person, right? (P-007-IPV).
Virtual if patient has difficulty coming to the hospital	…I hope that we can have, patients have the option to do appointments either in person or on the phone, depending on kind of what our needs are. For example, if you live far away or if we’re not feeling well, then you can do (the in-person or) on the phone or OTN, but if we are able to get down, then we can do those in-person (P-004-IPV).