Video consultations need to be re-examined as to their future utility, says report

A new report published this week revealed that only a small proportion of lung cancer patients are being offered video consultations, and also that lung cancer patients are more likely to be worried about receiving bad new if offered a virtual appointment.

Supported by Lung Cancer Nursing UK, the British Thoracic Oncology Group, UK Lung Cancer Coalition, and Roy Castle Lung Cancer Foundation the report, examined both patient and health professional perspectives on the increased use of virtual consultations in response to COVID-19.

Video consultations are a long way from becoming a new norm

Survey responses revealed that, despite the considerable increase in virtual appointments during the first wave of the pandemic, video was used in only 5% of patient consultations – with 51% of health professionals surveyed not using video for patient consultations at all. Furthermore, patients also expressed anxiety over video appointments, as around half of lung cancer patients reported that they would be ‘worried’ or ‘extremely worried’ if offered a video or telephone appointment (50 and 41 percent respectively) during the pandemic.

Nearly all patients (95 per cent), who were surveyed as part of the report, stated that meeting face-to-face was by far the best method of communicating their diagnosis – as well as having an initial consultation.

Lorraine Dallas, Director of Information, Prevention and Support, Roy Castle Lung Cancer Foundation said that: “Every patient worries about getting bad news and for healthcare professionals breaking bad news is one of the hardest aspects of their job. Virtual consultations are simply not appropriate in this situation, particularly as lung cancer patients tend to present at the late stage of their disease. Being told you have lung cancer, or your disease has become incurable is life-changing news – a phone or video consultation is not the right way to find out.”

However, the report also stated that nearly seven out of ten (69 per cent) patients are not given a choice between telephone or video. Moreover, more than three quarters (76 per cent) of healthcare professionals said they had not received any training or guidance for delivering virtual appointments. Furthermore, almost two-thirds (65 per cent) of health professionals said lack of computer equipment to hold video consultations was a common problem.

Professor Sanjay Popat, Consultant Thoracic Medical Oncologist, Royal Marsden NHS Foundation Trust, and Steering Committee Chair, the British Thoracic Oncology Group, commented: “The fact that video is so seldom used to deliver virtual consultations may surprise some people – but not those working within NHS hospitals.”

“This survey exposes some of the huge infrastructure changes that need to happen to make video consultations workable long-term in both secondary and tertiary lung cancer care settings.”

More convenient for but not preferred by patients

While 75 per cent of healthcare professionals agreed that video consultations were more convenient for patients – the report stated that only 30 per cent replied they were more convenient for them. Disadvantages include the inability to share visual material with their patients; greater difficulty in spotting a change in a patient’s condition; and the lack of a quiet, private, meeting spaces in hospitals to deliver video consultations.

Additionally, out of those patient respondents who had received a video consultation, many saw clear advantages with nearly three-quarters (71 per cent), again, citing that it was more convenient, by allowing them to avoid travelling into hospitals. And therefore, could see the untapped potential, especially for routine appointments.

Therefore, while video consultations feel like an inevitability, and are part of NHS England’s plan to cut carbon emissions and they feel like they are part of the societies move towards further digitalisation of services, there are teething problems as to its use in the clinical setting, and patients are not automatically supportive of it use.

As a result, the report highlighted a series of critical considerations to help improve the use of video (and telephone) consultations, and develop best practice tools – not only for lung cancer but other cancer services and the wider NHS:

• Further research is needed into the use of virtual consultations involving patients who do not have computer access or feel confident in using them, to ensure health inequalities are not being exacerbated.
• Healthcare professionals should be provided with training to support both communication and technical aspects involved in the delivery of virtual consultations.
• Given the often, late-stage, diagnosis and urgency that comes with it, there is a need for lung cancer-specific best practice guidelines which go beyond current general clinical guidance for the management of remote consultations.
• Resources will be needed if NHS Trusts are to invest in the technology needed to make virtual consultations an integral part of the patient pathway.