Completion rate and impact on physician-patient relationship of video consultations in medical oncology: a randomised controlled open-label trial

Abstract

Background: Mobile phone video call applications generally did not undergo testing in randomised controlled clinical trials prior to their implementation in patient care regarding the rate of successful patient visits and impact on the physician-patient relationship.

Methods: The National Center for Tumour Diseases (NCT) MOBILE trial was a monocentric open-label randomised controlled clinical trial of patients with solid tumours undergoing systemic cancer therapy with need of a follow-up visit with their consulting physician at outpatient clinics. 66 patients were 1:1 randomised to receive either a standard in-person follow-up visit at outpatient clinics or a video call via a mobile phone application. The primary outcome was feasibility defined as the proportion of patients successfully completing the first follow-up visit. Secondary outcomes included success rate of further video calls, time spent by patient and physician, patient satisfaction and quality of physician-patient relationship.

Findings: Success rate of the first follow-up visit in the intention-to-treat cohort was 87.9% (29 of 33) for in-person visits and 78.8% (26 of 33) for video calls (relative risk: RR 0.90, 95% CI 0.70 to 1.13, p=0.51). The most common reasons for failure were software incompatibility in the video call and no-show in the in-person visit arm. The success rate for further video visits was 91.7% (11 of 12). Standardised patient questionnaires showed significantly decreased total time spent and less direct costs for patients (Δmean -170.8 min, 95% CI -246 min to -95.5 min), p<0.0001; Δmean -€14.37, 95% CI -€23.9 to -€4.8, p<0.005) and comparable time spent for physicians in the video call arm (Δmean 0.5 min, 95% CI -5.4 min to 6.4 min, p=0.86). Physician-patient relationship quality mean scores assessed by a validated standardised questionnaire were higher in the video call arm (1.13-fold, p=0.02).

Interpretation: Follow-up visits with the tested mobile phone video call application were feasible but software compatibility should be critically evaluated.

Trial registration number: DRKS00015788.

Keywords: digital health; physician-patient relationship; shared decision-making; smartphone; telemedicine.

Figure 1

CONSORT flow chart. Reasons for exclusion/failure are highlighted with bullet points. CONSORT, Consolidated Standards of Reporting Trials; ECOG, Eastern Cooperative Oncology Group; Q1, questionnaire Q1; Q2, questionnaire; VC, video call.

Figure 2

Success rate of video call and in-person visits. Stacked bar graphs indicating success rates of patients in the in-person visit and video call arms. (A) Success rates at first scheduled appointment in the in-person and video call arms (prespecified). (B) Success rates for video call appointments at the first scheduled and at any additional appointments (exploratory). P value was calculated using Fisher’s exact test.

Figure 3

Appointment characteristics and patient satisfaction. Components of the appointment, patient satisfaction, time and cost were assessed for the first scheduled appointment. (A) Stacked bars indicating characteristics of the first appointment in the in-person and video call arms. (B) Box plots indicating different dimensions of patient satisfaction and the desire to repeat the appointment in the in-person (n=26) or video call (n=22) group. P values were calculated using Mann-Whitney U tests (two sided). (A, B) Indicated are descriptive titles for the items. (C) Box plots indicating total time spent for physicians (n=47) and patients (n=39). P values were calculated using unpaired t-tests (two sided). (D) Box plots indicating total direct (n=29) and indirect costs (n=15) for patients in the in-person and video call arm. P values were calculated using unpaired t-tests (two sided). (B–D) Multiple comparisons were accounted for using the Benjamini-Hochberg method within each panel (A–D). Statistically significant exploratory comparisons are indicated with an asterisk (q<0.05). Boxes indicate IQR, bars indicate median and whiskers range.

Figure 4

Physician–patient relationship assessment using the questionnaire on quality of physician–patient interaction. Physician–patient relationship after the first appointment was assessed using the Questionnaire on Quality of Physician–Patient Interaction (QQPPI) Questionnaire. (A) Box plots indicating QQPPI total score in the in-person (n=18) and video call groups (n=18). (B) Box plots indicating patient agreement with individual items of the QQPPI questionnaire (n=48). Indicated are descriptive titles for the items. (A, B) P values were calculated using Mann-Whitney-U tests. Multiple comparisons were accounted for using the Benjamini-Hochberg method. Asterisks indicate significant exploratory comparisons (q<0.05). Boxes indicate IQR, bars indicate median and whiskers range.