Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care. (14th May 2022)

• Record Type: Journal Article
• Authors: Du, Eric Y.; Moody, Rylee A.; Simpson, Matthew C.; Nellore, Aditya; Sinnwell, Joseph G.; Heiland, Luke D.; Grace, Shane A.; Chen, Collin L.
• Is Part Of: Laryngoscope. Volume 133:Number 2(2023)
• Page Start: 294
• Page End: 301
• Publication Date: 2022-05-14
• Subjects: telemedicine -- telehealth -- skin cancer -- reconstructive surgery -- preference -- cross‐sectional; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.30215
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives: Identify which delivery modality for skin reconstruction care, face‐to‐face (FTF) in‐person versus two telemedicine modalities, store‐and‐forward (S&F) and live video chat (LVC), is patient preferred and how cost, access, wait time, and demographics influence this preference. Study Design: Cross‐sectional survey. Methods: A 16‐question survey querying demographics and five scenario‐specific preferences questions for the delivery of skin cancer reconstruction care was created and distributed via Amazon Mechanical Turk (MTurk), a crowdsourcing online marketplace, and in‐person to Mohs micrographic surgery patients. Results: 1394 MTurk and 55 in‐person responses were included. While 82.1% of online respondents prefer FTF clinic visits, this decreases to 58.3% with an in‐person visit cost ( p < 0.01) and furthermore to a minority 43.5% with both an in‐person visit cost and wait time ( p < 0.01) despite 77.8% believing that usefulness to the surgeon would improve FTF. Both the MTurk and in‐person cohorts demonstrated similar response patterns despite considerable demographic differences. Multivariable analyses revealed that telemedicine was preferred by MTurk respondents with Medicaid (adjusted OR [95% CI]: 1.97 [1.18–3.31]) or Medicare (1.69 [1.10–2.59]) versus private insurance, and prior skin cancer (2.01 [1.18–3.42]) and less preferred by those earning $140, 000+ per year (0.49 [0.29–0.82]) compared to those earning <$20, 000 per year. Conclusions: FTF visits are preferred for skin cancer reconstruction care; this shifts toward virtual care with a cost and wait time in spite of the perceived quality of care. Individuals with socioeconomic barriers to access prefer telemedicine. MTurk can be a valuable tool for behavioral research in FPRS. Level of Evidence: NA Laryngoscope, 133:294–301, 2023 Abstract : Telemedicine is here to stay; we aimed to identify which delivery modality for skin reconstruction care is patient preferred and influences of this preference. In‐person visits are preferred but this shifts toward virtual care with a cost and wait time in spite of perceived quality of care or age. Individuals with socioeconomic barriers to access prefer telemedicine.