1- english editing (just to make the paragraphs connected and idea easily flow and connected) Over the past few years virtual clinics have offered their services for acute and chronic care patients. The safety and validity of this type of medical care has been examined in many randomized controlled trials in terms of the accuracy of acute care diagnosis and the treatment offered. Although Telehealth is not new, the COVID-19 pandemic has forced specialities that rely heavily on person visits to offer alternative forms of health care for their patients with both acute and chronic health conditions as reducing both patient and healthcare providers exposure to the virus became paramount.1,2 Cancer care has always been a priority as most cancer patients tend to have access to a health care provider in a timely fashion due to the nature of their disease, the need for treatment and potentially surgery. Until this pandemic, the need for a fast and remote access virtual consultation service was not necessary for metropolitan cancer centres. The covid-19 pandemic presents a unique challenge for cancer care worldwide, specifically because these patients have a greater susceptibility to illness and death from the virus.4 Further, cancer patients have been observed to have a greater risk of being admitted to the ICU, needing ventilation support and death from covid-19 due to their immunosuppressive states compounded by their increased number of hospital visits.5 In addition, patients who had recently undergone chemotherapy or a surgical procedure were at an even greater risk.5 Cancer care has always been a priority as most cancer patients tend to have access to a health care provider in a timely fashion due to the nature of their disease, the need for treatment and potentially surgery. Until this pandemic, the need for a fast and remote access virtual consultation service was not necessary for metropolitan cancer centres. It is evident there are clear benefits to telehealth virtual visits, specifically for patients who live in more remote and rural areas.1,3,6 Although telehealth has been shown to offer a cost-effective approach to medical care in certain specialities, very little research has evaluated the benefits, specifically in terms of patient satisfaction, that telehealth plays in more high-risk patient populations such as those in gynecologic-oncology.3 There is no doubt that the rapid adoption of telehealth services has allowed patients’ to have continuity of care, however, how does this shift in medical care delivery, although grounded in necessity, translate into quality care for chronically ill or immunocompromised patients ?2,3 Prior to the COVID-19 pandemic, the majority of research evaluating cancer patients’ experience with telehealth has been in rural setting, regardless, patients’ reviews have been largely positive.3,6 Our preliminary pilot study aims to evaluate gynecologic-oncology patients’ satisfaction with their telehealth visit, in a urban setting, during the COVID-19 pandemic in hopes of diminishing barriers to care while providing adequate health care alternatives for this vulnerable patient population. This study, the first of its kind the country, reports our patients’ experience and specifically their satisfaction with the telehealth platform. Our purpose is to measure the degree of patients’ satisfaction with the virtual visit during the COVID-19 pandemic and to use this information to inform future decisions regarding telehealth in our clinics. Methods editing / I have a list of the questions that were asked I can send them if you think they should be put in the methods? I was just not sure how to include them. This pilot study is a retrospective, single-institution, questionnaire-based study comparing patients’ satisfaction with their virtual visit versus in-person visit, conducted at the womens General Hospital between August 1st 2020 to August 31st 2020. A twenty question survey was completed with all our outpatient gynecological oncology patients including all consecutive women with new consultation visits, women on active chemotherapy or active maintenance treatment with PARP inhibitors. We used an internally validated survey that was constructed by the quality improvement team at the womens General Hospital, the research team then tailored the survey to the specific needs of our patient population. Approval from our local Institutional Review Board was obtained. Information with respect to patient’s responses regarding time management, safety, confidentiality, access, and quality of care received in our clinic was gathered. The patients were called by a third party volunteer to ensure the survey was completed without bias and in a standardized format. Demographic information was collected. At the end of the survey, the participants were asked how they would improve the telemedicine services offered to them, or if they had any additional comments to share. Results: edit english and flow of paragraph ( to make sure they make sense) In total, 254 patients were called, 142 patients of which completed the survey. 57 patients were not interested in participating, 48 patients did not answer the phone, and 7 were deceased. Overall, the 142 patients expressed satisfaction with their telehealth experience, with 49.3% of them noting that they would change nothing of their experience. Most Telehealth appointments were for ‘surveillance,’ (61%) of which, patients felt, could easily be conducted via a visual platform, rather than just audio. Other reasons for virtual care visits were active chemotherapy (15%), post-operation (22%), or a new patient (2%). No matter the reason, 84% of participants thought the Virtual Health Services they received were appropriate based on the reason for my consultation and the services offered responded to 71% of patients’ needs. Most appointments (94%) were conducted over the phone which was found to be a factor of dissatisfaction with regards to the platform used for the virtual health appointment.. 15.5% of the patients shared that they would prefer video calls for their future appointments. Nevertheless, 89% of patients stated that the healthcare professionals were well heard over the phone. Those who had their appointments over the video calls (6%) were able to see the healthcare provider clearly (75%). Another concern was that patients felt they needed to ask more questions once the appointment was finished in 31% of patients. This may be due to the fact that 70% of patients felt that they were not prepared prior to their visit. The majority of the patients were ages 55-74. Despite a relatively older age population, 27% of participants were very comfortable using technology, and 36% were moderately comfortable. Only 8% felt extremely uncomfortable. Additionally, 87% of the participants felt strongly that they were not worried about the confidentiality of the information being discussed.The virtual visit saved both time and money in well over the majority of cases. 89% of patients did not need to visit the Emergency Room or another healthcare provider within 2 weeks of their virtual visit for their gynecologic oncology condition. Outside of the context of a global pandemic, if given the choice between an in-person visit and a Virtual Care visit, 25% would strongly agree to keeping virtual visits, while 37% strongly disagreed. To the question ‘would you recommend Virtual Visits to other patients?’ 64% of patients said yes, 24% said maybe, and 12% said no. 56% of patients rated the empathy of the healthcare provider during the Virtual Visit a 10/10 39% of patients felt that the overall quality of healthcare they received during the Virtual Visit compared to an in person visit was 10/10. Discussion This is where I need the most help, feel free to introduce new points or ideas that you feel are relevant. I need to make the point that “Further, while telehealth is being depicted as one of the major pandemic-related changes that will retain after the current situation, it is crucial to assess whether this type of interaction is accepted by patients and also favored for the future.” but I need to paraphrase this. patient’s stated that they felt rushed I need to say something that explains that the limitations of this study is that it’s a pilot study, retrospective, we didn'tt have a large percentage of video calls , and relatevely small sample size ( this will be fixed in the second phase of the study where we will implement more instruction on the hospital website regarding what question will be asked during clinic and attempt to increase the ratio of video phone calls) the strengths would be that it’s the first in the canada to look into telemedince in a city , third party was calling the patient with the survey ( not part of the treating team) collected the information which reduces the chances of biases. This pilot study was designed and implemented with the goal of understanding how gynecologic oncology patients feel about telemedicine with the overarching goal of deciding whether virtual services should continue after the COVID-19 pandemic and if so in what capacity. This study is the first of its kind in an urban area in Canada. Similar to recently published results, our preliminary study’s results indicated that, overall, patients are satisfied with the experience (ADD SOURCES). Although the questions asked were helpful to our understanding, the comments received are setting the outline for our phase two of the study. Attempts to implement some of the patients suggestions. For example, the main comment was that the patients would prefer to use a video platform, rather than just audio. Another prevalent problem was that patients felt nervous during the call, leading them to forget the questions they had planned to ask. One solution will be to post a questionnaire on the department patient education website, delineating what the doctor will be asking the patient. Hopefully this will spark questions they may have, which they can write down on the paper to help them remember. After some time with these changes in place, the patients will be called again to discuss how they felt about the improvements made. In the next phase, we will also stratify the results from the pilot based on where the patients are in their cancer journey, from acute illness to chronic treatment. No matter the improvements made, we understand that telemedicine cannot replace in person gynaecology oncology visits, however, this platform will be able to offer additional ways to deliver care. The COVID-19 pandemic is not finished yet, and as such adaptation to the new norm is necessary as we enter a more chronic stage of this pandemic.4 It is inherent and understood that virtual care in the capacity of gynecology, oncology, or both can be challenging. While telehealth visits do not compare to those held in person, it is a safety risk for this vulnerable population to visit their physician in person at this time. As such, our goal is to make the difference between at home and in person visits as minimal as possible. Conclusion: A paragraph saying that This study Confirms results from other studies Shows that theres a space for telehealth in gyn-onc though not a complete replacement References [1] Ramaswamy A, Yu M, Drangsholt S, Ng E, Culligan PJ, Schlegel PN, Hu JC. Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study. J Med Internet Res. 2020 Sep 9;22(9):e20786. doi: 10.2196/20786. PMID: 32810841; PMCID: PMC7511224. [2] Andrews E, Berghofer K, Long J, Prescott A, Caboral-Stevens M. Satisfaction with the use of telehealth during COVID-19: An integrative review. Int J Nurs Stud Adv. 2020 Nov;2:100008. doi: 10.1016/j.ijnsa.2020.100008. Epub 2020 Oct 16. PMID: 33083791; PMCID: PMC7564757. [3] Zimmerman BS, Seidman D, Berger N, Cascetta KP, Nezolosky M, Trlica K, Ryncarz A, Keeton C, Moshier E, Tiersten A. Patient Perception of Telehealth Services for Breast and Gynecologic Oncology Care during the COVID-19 Pandemic: A Single Center Survey-based Study. J Breast Cancer. 2020 Oct 19;23(5):542-552. doi: 10.4048/jbc.2020.23.e56. PMID: 33154829; PMCID: PMC7604367. [4] Rodler, S., Apfelbeck, M., Schulz, G. B., Ivanova, T., Buchner, A., Staehler, M., Heinemann, V., Stief, C., & Casuscelli, J. (2020). Telehealth in Uro-oncology Beyond the Pandemic: Toll or Lifesaver?. European urology focus, 6(5), 1097–1103. https://doiorg.ezlibrary.technion.ac.il/10.1016/j.euf.2020.05.010 [5]Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21:335–7. [6] Shaverdian, N., Gillespie, E. F., Cha, E., Kim, S. Y., Benvengo, S., Chino, F., Kang, J. J., Li, Y., Atkinson, T. M., Lee, N., Washington, C. M., Cahlon, O., & Gomez, D. R. (2021). Impact of Telemedicine on Patient Satisfaction and Perceptions of Care Quality in Radiation Oncology. Journal of the National Comprehensive Cancer Network : JNCCN, 1–7. Advance online publication. https://doi-org.ezlibrary.technion.ac.il/10.6004/jnccn.2020.7687
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