Barriers and facilitators to teleoncology care delivery for cognitively impaired older cancer patients: Clinician perspectives.

Abstract

e13710 Background: Telehealth has improved access to care and is increasingly used in oncology. However, its expansion has outpaced evidence on how to deliver effective care to older cancer patients with cognitive impairment (CI). Our objective was to understand barriers and facilitators to delivering teleoncology care to cancer patients with CI from the perspective of clinicians. Methods: We conducted semi-structured interviews with clinicians at San Francisco VA Oncology Clinic from September-December 2025. Clinicians were asked to reflect on challenges with teleoncology care in general and for patients with diagnosed or suspected CI. Interviews were guided by the Consolidated Framework for Implementation Research and covered experiences across the following domains: 1) physical (e.g. exam), 2) decisional (e.g. medical decision-making), 3) emotional (e.g. rapport, emotional support), 4) technological/structural (e.g. audio quality, telehealth infrastructure). Study team members analyzed transcripts using rapid qualitative analysis. Results: We interviewed 10 clinicians with expertise spanning solid and hematologic malignancies. On average, clinicians reported 48% in-person, 25% video, and 27% phone visits. Clinicians identified challenges in each domain and their impact on patient care: 1) Physical: the inability to perform a physical exam impedes patient assessment, which is magnified in CI patients who may provide less reliable history or symptom reporting; 2) Decisional: difficulty determining functional status and treatment candidacy via telehealth, which hinders shared decision-making with CI patients; 3) Emotional: building rapport with patients is harder over telehealth and magnified with CI patients who may need more emotional support; 4) technological/structural: clinicians reported patients often had challenges connecting to the VA video platform, resulting in frequent conversion to phone visits which were inferior to video in all domains, particularly for patients with CI. Clinicians identified the following facilitators to help them provide more effective teleoncology care: virtual vitals, supportive caregivers, tools for patient education and clinician workflow, support staff, and information technology support. Clinicians noted most veterans liked how telehealth increased access to oncology care, especially for rural and frail veterans. Conclusions: Despite the potential for teleoncology to increase access for older adults, there are additional challenges for CI patients, especially if relying on phone visits, that impair the quality of care. Findings from this study will be combined with interview findings from patients and caregivers to inform development of an intervention to improve delivery of teleoncology care to CI patients.