Rachel Conklin, MMS, PA-C, and her team in the Department of Radiation Oncology at Vanderbilt-Ingram Cancer Center (VICC) are exploring the use of telehealth to increase access to their radiation oncology survivorship program for patients who receive care at their satellite radiation treatment facilities. These clinics serve a large area including rural counties and communities located remotely from the main campus clinic in Nashville, TN. Currently, few of the patients who receive radiation therapy at the satellite treatment facilities receive survivorship care because they decline to travel to Nashville where the survivorship program is located. Using telehealth to offer the services of the Vanderbilt Radiation Oncology Survivorship Program at the community facilities is helping to alleviate the burden of commuting to a new clinic in Nashville and to provide the care in a more familiar setting, closer to home.
Q&A with Rachel Conklin, MMS, PA-C
What inspired you to use telehealth in your cancer survivorship program?
Our initial objective was to expand the reach of the survivorship program to all our patients completing definitive treatment at our main campus and satellite facilities. We realized the limitations of provider time and location, patient location, comfort and resources to travel for our satellite patients, and we started looking for innovative solutions. Our department chair, Dr. Lisa Kachnic, identified a potential resource with the telehealth team that was just starting to support developing telemedicine programs at our institution. This approach provided a solution to our needs, and we were able to design a telehealthenabled survivorship follow-up visit that includes elements of disease surveillance, attention to survivorship concerns and a full comprehensive physical exam.
Additionally, our department, in partnership with the executive leadership of Vanderbilt-Ingram Cancer Center, has been working to meet our Commission on Cancer (CoC) Standard 3.3 for Survivorship: delivery of a Survivorship Care Plan to at least 50 percent of our patients completing curative treatment. In October of 2017, the CoC approved telehealth as a means of delivery of the Survivorship Care Plan. This program will enable us to also reach this goal at our satellite facilities.
How could your research help other radiation oncology professionals?
We hope to demonstrate acceptability of the telemedicine care delivery model by our patient population following completion of radiation therapy. This has not been demonstrated in a population of cancer survivors in a radiation oncology followup setting. We also anticipate hearing constructive feedback from patients on areas for improvement with the visits and technology. If we are successful, we could provide a template for a scalable model for radiation oncology remote patient visits that could translate across service lines. This could potentially increase the bandwidth of radiation oncology professionals to reach more patients, for consultation and for follow-up, while gathering useful feedback in real-time on the experience.
How do you hope this research will help cancer survivors?
Helping patients maximize their quality of life and improve overall self-management related to their cancer history and risks are two main areas of focus of our survivorship program. With this study, we hope to demonstrate benefit of the visit using the telemedicine care model with showing completion of disease surveillance and implementation of healthy lifestyle and behavior suggestions reviewed during the visit and presented in the Survivorship Care Plan. As an exploratory aim, we will evaluate change in patient health-related quality of life and self-efficacy to manage chronic disease prior to and following the visit. This aim may identify potential benefit and support further exploration of these important survivorship outcomes in a larger cohort.
How is the grant from the ROI supporting your team’s research goals?
We are grateful for the ROI funding which has enabled our team to commit more expertise, time and resources within our department to the careful clinical and research programmatic planning and execution for this service. We have been able to increase the participating satellite programs from one to three facilities with this additional support. We have also been able to develop and utilize tablet-based surveys to allow for convenient and quick completion and collection of the validated survey instruments related to our aims.
How do you see telehealth fitting into the future of radiation oncology?
Telehealth provides a platform that can connect radiation oncology professionals to patients and other professionals who are located remotely. This could shape not only how follow-up care is executed but also how initial consultations with specialized radiation oncologists can be considered for patients living remotely. We envision that telehealth will have a large impact on increasing access to specialty care and expertise in radiation types of radiation oncology professionals working together to deliver this care.