Lily L Lai1, Heather Player2, Sherry Hite3, Vikas Satyananda4, Jennelle Stacey5, Virginia Sun6, Veronica Jones7, Jennifer Hayter8. 1. Lily L. Lai, MD, is Associate Clinical Professor, Department of Surgery, City of Hope, Duarte, CA; llai@coh.org. 2. Heather Player, MD, is Assistant Clinical Professor, Department of Surgery, City of Hope, Duarte, CA. 3. Sherry Hite, MOT, OTR/L, is Occupational Therapy Manager, Department of Rehabilitation Services, City of Hope, Duarte, CA. 4. Vikas Satyananda, MD, is Surgical Oncology Fellow, Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY. 5. Jennelle Stacey, BA, is Rehabilitation Aide, Department of Rehabilitation Services, City of Hope, Duarte, CA. 6. Virginia Sun, PhD, RN, is Associate Professor, Department of Population Sciences, City of Hope, Duarte, CA. 7. Veronica Jones, MD, is Assistant Clinical Professor, Department of Surgery, City of Hope, Duarte, CA. 8. Jennifer Hayter, MA, OTR/L, CLT-LANA, is Executive Director, Department of Rehabilitation Services, City of Hope, Duarte, CA.
Abstract
IMPORTANCE: Access to perioperative breast surgery occupational therapy services remains limited in remote areas. OBJECTIVE: To assess the feasibility and acceptance of occupational therapy services using a "hub-and-spoke" telemedicine model. DESIGN: Prospective study using videoconferencing to connect the occupational therapist, located at the hub site, with the patient, located at the spoke site. SETTING: National Cancer Institute Comprehensive Cancer Center (hub site) and affiliated community cancer center (spoke site). The sites are 75 mi apart. PARTICIPANTS: Female breast cancer patients (N = 26) scheduled for breast surgery were asked to participate in telemedicine occupation therapy sessions. Patients lived in a geographically remote region and travelled a mean of 16 miles (range = 3-85) to the hub site. The majority (56%) of the patients had public insurance. INTERVENTION: Perioperative occupational therapy sessions completed through videoconferencing. OUTCOMES AND MEASURES: Outcome measures were participation in and completion rate for the sessions, number of sessions required to return to baseline, and time interval from surgery to return to baseline function. Patient satisfaction was assessed with a questionnaire. RESULTS: Of the patients who enrolled in the study, 18 completed all postoperative sessions in which functional assessments, exercises, and education were provided. Patients regained baseline function within a mean of 42.4 days after surgery and after an average of three sessions. Patients reported high satisfaction with the sessions. CONCLUSIONS AND RELEVANCE: Videoconference telemedicine in breast perioperative rehabilitation is feasible, effective, and acceptable to patients. This study adds to the emerging use of telemedicine for rehabilitative services. WHAT THIS ARTICLE ADDS: This study, by demonstrating the acceptability, practicality, and efficacy of breast perioperative occupational therapy services offered through a videoconferencing platform, supports continued research to evaluate the value of telemedicine. Issues with access to medical care may be mitigated through creative use of technology.
IMPORTANCE: Access to perioperative breast surgery occupational therapy services remains limited in remote areas. OBJECTIVE: To assess the feasibility and acceptance of occupational therapy services using a "hub-and-spoke" telemedicine model. DESIGN: Prospective study using videoconferencing to connect the occupational therapist, located at the hub site, with the patient, located at the spoke site. SETTING: National Cancer Institute Comprehensive Cancer Center (hub site) and affiliated community cancer center (spoke site). The sites are 75 mi apart. PARTICIPANTS: Female breast cancer patients (N = 26) scheduled for breast surgery were asked to participate in telemedicine occupation therapy sessions. Patients lived in a geographically remote region and travelled a mean of 16 miles (range = 3-85) to the hub site. The majority (56%) of the patients had public insurance. INTERVENTION: Perioperative occupational therapy sessions completed through videoconferencing. OUTCOMES AND MEASURES: Outcome measures were participation in and completion rate for the sessions, number of sessions required to return to baseline, and time interval from surgery to return to baseline function. Patient satisfaction was assessed with a questionnaire. RESULTS: Of the patients who enrolled in the study, 18 completed all postoperative sessions in which functional assessments, exercises, and education were provided. Patients regained baseline function within a mean of 42.4 days after surgery and after an average of three sessions. Patients reported high satisfaction with the sessions. CONCLUSIONS AND RELEVANCE: Videoconference telemedicine in breast perioperative rehabilitation is feasible, effective, and acceptable to patients. This study adds to the emerging use of telemedicine for rehabilitative services. WHAT THIS ARTICLE ADDS: This study, by demonstrating the acceptability, practicality, and efficacy of breast perioperative occupational therapy services offered through a videoconferencing platform, supports continued research to evaluate the value of telemedicine. Issues with access to medical care may be mitigated through creative use of technology.
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