COVID-19, a natural experiment. Did it create an opportunity to reduce racial disparities in psychosocial oncology and change how we deliver care?

Abstract

Purpose: There is evidence to support the acceptability of telehealth among oncology patients, but inconsistencies regarding access and use in underserved populations.

Aims: This study used the COVID-19 pandemic as a natural experiment to test whether implementation of telehealth for patients referred to a psychosocial oncology (PSO) service would 1) increase PSO access and utilization and 2) reduce racial disparities.

Methods: Demographic, medical and appointment completion data for patients referred to a PSO service at an NCI-Designated Comprehensive Cancer Center from March, 2018 to March, 2022 were examined. Descriptive and multivariate logistical regression analyses at both the patient and visit level were conducted. Outcomes were patient follow-up (i.e. ≥ one scheduled PSO appointment) and visit outcome (completed vs. canceled/no-show).

Results: The sample included 934 White and 610 Black adult patients (69.8% female) aged 18-95 (M = 56.0, SD = 15.3) who scheduled 5,782 PSO visits. Follow-up rates significantly increased post-COVID among White (66.2%-72.2%; Z = 2.17, p = .03), but not Black patients (73.6%-70.4%; Z = 0.88, p = .38). Among N = 1,089 patients who scheduled at least one PSO appointment, telehealth had a significant effect on visit outcomes (X² = 466.6, df = 2, p < .001). Completed appointments increased (52.5%-79.2%), while rates of canceled (21.8%-11.2%) and no-show appointments (25.7%-9.6%) decreased. Moreover, telehealth resulted in a significantly greater increase in completed appointments for Black patients (44.7%-74.3%), in comparison to White patients (59.4%-81.4%; X² = 4.02, df = 1, p = .045).

Conclusions: Black patients were less likely than White patients to show an increase in follow-up with PSO services following onset of COVID. However, among patients with one or more scheduled appointments, the use of telehealth significantly decreased racial disparities in appointment completion rates. Findings suggest that the relationship between telehealth and racial disparities in PSO care is nuanced.

Keywords: COVID-19; Psychosocial oncology; ethnic and racial minorities; populations; telehealth; vulnerable.