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To the Editor
In March 2020 we published a rapid review of the use of video consultations in palliative care during the COVID-19 pandemic.1 We suggested that although video consultation cannot fully replace face-to-face encounters it could radically reduce the need for them and offer an effective, accessible, acceptable and cost-effective alternative. We now report patient feedback on our video consultation use in a palliative care service, both the value and the challenges in an adult community service.
From May to December 2020 we conducted 170 virtual consultations between patients and members of the Community Palliative Care Team based at Sobell House, Oxford using Attend Anywhere software. A range of professionals were involved, including doctors (24 consultations), occupational therapists and physiotherapists (54 consultations), specialist nurses (29 consultations) and lymphoedema practitioners (63 consultations). Patients ranged in age from 18 to over 65s, with nearly half (48%) in the latter age band.
Feedback was sought routinely from all patients via a short SurveyMonkey form that appeared at the end of the consultation, when the consultation window closed, to enable continuous service evaluation and organisational learning. Of the patients, 85% felt that the virtual platform offered the same or better experience to face-to-face consultations, with 96% being open to further appointments in this format.
The positive impact of virtual consultations for the patients appeared to be predominantly logistical, with patients largely finding it a more convenient medium (59%), including time saved travelling (65%) or parking (52%), and reduction in cost (32%) or stress (33%). Interestingly, most patients also preferred this medium to telephone consultation (96%). An unanticipated advantage was the ability to lip-read for patients with hearing impairment, as this would currently be impeded by the need for face coverings to be worn during a face-to face consultation.
Concerns have been raised in the literature around the accessibility of such platforms and so we were relieved to find that the majority of patients felt able to set up the consultation themselves (74%) and knew who to contact if they struggled (78%). Patients used a variety of their own devices, including laptops, personal computers, tablets and smart phones, and the majority (90%) took less than an hour to prepare for the consultation, suggesting a positive sense of accessibility.
Sadly, technical issues did affect some consultations: 12% had to be abandoned due to such problems; 25% had some degree of technical difficulty, predominantly with audio or video quality (93%); and in a smaller number with internet connectivity (5%). A small minority of patients felt that they had not been able to express their problems adequately over video (2%), or that it had been more stressful (1%) or time-consuming (1%). Additionally, for 9% of patients the inability to have a physical examination undertaken was felt by the patient to be a significant weakness.
It is vital that we do not see virtual consultations as a panacea and that we recognise their challenges. Virtual consultations are not the same as face-to-face consultations and thus training for professionals in not just the logistics but the unique communication challenges they pose is vital.2 3 Additionally, they cannot be used as a substitute to physical examination and cannot replace the use of therapeutic physical contact. While video consultation could be embedded in practice beyond the pandemic, to enhance our services this will require a culture shift from the presumption that face-to-face review is always the most desirable modality for reviewing patients. We aim to seek staff views on the new service to help evaluate the scope for use of video consultation in our usual practice, the barriers to achieving this and the desire for this in the future.
Additionally, we must guard against the risk of digitally excluding patients from our services. This evaluation fails to capture those patients who could not engage in virtual consultations due to lack of technical skills, technology or reliable internet connection. Despite the relative affluence of our county we recognise there were 34 000 people within Oxfordshire who have been unable to access the internet in any form in the first national lockdown in the UK.4 Thus it is prudent to consider that a shift to greater use of digital technology risks reducing access to healthcare for those who are socioeconomically or digitally disadvantaged and to ensure alternatives, such as telephone assessment and face-to-face review when necessary, are also available to mitigate the risk of exacerbating ensuant health inequalities.5
In conclusion, our patient feedback suggests that the majority of patients who accessed the service felt video consultations offer an acceptable and effective alternative to face-to-face consultation while minimising face-to-face interaction during a pandemic. Video consultations, far from being a ‘second best’ option, could in fact enhance our service, offering a useful time-efficient, low-cost, low-stress option for patient assessment in the post-COVID-19 era. However, it is essential that we balance this enthusiasm with vigilance for the needs of those who may be digitally excluded.
Ethics statements
Patient consent for publication
Footnotes
Contributors VB retrieved and analysed the data and prepared the draft manuscript. AES collated author comments and prepared the final manuscript. AES, VB, MW, JS and BW all contributed to the final article. VB and BW had supervising author input throughout the drafting of the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.