Telehealth gets a tick for follow-up melanoma care


By Geir O'Rourke

14 Nov 2023

Most patients with melanoma report high satisfaction with telehealth for follow-up care, indicating phone and video consultations are likely to remain in high demand long after the COVID-19 pandemic, a study has found.

While no replacement for face-to-face medicine, the technology should be a useful adjunct in the long term, particularly if it is enhanced to improve patient satisfaction, according to the researchers.

It comes as the federal government considers yet another revamp of the Medicare funding for specialist telehealth, which would see permanent items created for subsequent consultations conducted via both phone and video.

On the other hand, all initial consultations would need to be conducted in-person, under the changes proposed by the MBS Review Advisory Committee.

Conducted across three specialist melanoma centres in Sydney, the cross-sectional study included 115 patients and 13 clinicians who answered surveys on their satisfaction with telehealth.

Among the 109 patients who had used telehealth, half said they preferred face-to-face consultations, while a third said they preferred a combination of the two.

Just five (4%) patients expressed a preference to receive all their follow-up care remotely, the researchers reported in Cancer Medicine (link here).

Interestingly, patient preferences differed from those of clinicians, 69% of whom preferred telehealth, they noted.

“Clinicians and patients were congruent in expressing convenience, safety and improved access to care as benefits of telehealth, consistent with previously reported research,” the research team added.

“Patients also reported that telehealth allowed family and friends to be present in a supportive role during the consultation, without a major impact on the family member/friend’s routines.”

But there were variations among the patients surveyed, with those diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns likely to report lower satisfaction with telehealth.

Additionally, those who reported higher supportive care concerns and who were not experienced in using telehealth tended to have lower telehealth satisfaction, the researchers said.

“If telehealth is offered to these patients, their clinicians may wish to discuss additional guidance and support strategies with them, to ensure both have a satisfactory experience,” they said.

Suggested changes to improve the experience included wider adoption of video, with use of suitable videoconferencing platforms, closed captioning for people hard of hearing and “virtual waiting rooms” to improve communication with patients when a clinician is late, for example.

Meanwhile, a scoping review on store-and-forward teledermatology (SAFT) also found generally positive outcomes.

Based on 12 studies evaluating doctor-to-dermatologist Australian SAFT services, the reviewers labelled the increasingly popular technology a “promising solution” addressing healthcare inequalities and underservicing, particularly for rural patients.

Importantly, such models allowed patients access to timely specialist opinion without the need for travel, and could be used for all skin conditions, the researchers reported in Australasian Journal of Dermatology (link here).

“The SAFT services improve diagnostic accuracy for patients when compared to no specialist input at all,” they added.

Nevertheless, the team stressed more research was needed, particularly as the model became more widespread and patient preferences shifted in the post-COVID era.

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