Using video consultations for clinical assessment and decision of treatment readiness before chemotherapy: A mixed-methods study among patients with gastrointestinal cancer and oncology nurses

Abstract

Objective

To investigate the feasibility of clinical assessment and decision of treatment readiness before chemotherapy using video consultations, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, to estimate reductions in travel time for patients and environmental carbon dioxide (CO₂) emissions.

Methods

In a mixed-method study, patients with gastrointestinal cancer who participated in at least one video consultation during April–October 2019 completed a questionnaire on socioeconomic status, time and kilometers saved on travel. Kilometers saved were converted into reduced CO₂ emissions. Descriptive statistics were used for analysis. Patients (n = 15) participated in semi-structured individual interviews, and five oncology nurses participated in a focus group interview.

Results

A total of 84/119 patients (71%) consented to video consultation and responded to the questionnaire. 69% were male, with a mean age of 66 years. For 46% of patients, a video consultation saved more than an hour of travel time. Avoiding a median travel distance of 120 km per patient (range, 2–450 km) reduced CO₂ emissions by 7018 lb. Video consultations had other positive effects on patients, including avoiding waiting rooms, having more energy, and experiencing more focused interactions with nurses. Technical issues occurred rarely. Nurses found technical issues more troublesome, sometimes precluding complete assessments. They reported a need to rethink nursing practice to effectively provide care during video consultations.

Conclusions

Video consultations reduced CO₂ emissions. In addition, they were beneficial for patients with gastrointestinal cancer. However, providing an optimal clinical assessment and decision of treatment readiness before chemotherapy requires testing patient equipment, technical skills and new oncology nursing competencies.

Keywords

Telemedicine video consultation oncology cancer nursing communication symptom assessment side effects treatment readiness

Introduction

Patients with gastrointestinal cancer are often treated with chemotherapy in several cycles, necessitating a thorough pretreatment assessment of performance status, symptoms and side effects.¹ The most common side effects are nausea, impact on mucous membranes and peripheral neuropathy.² Assessing side effects is a key task for cancer nurses. Traditional in-person oncology care allows them to assess ‘patients’ physical and psychosocial well-being before the next chemotherapy cycle.³ However, patients with gastrointestinal cancer are often older and vulnerable⁴ and may live at a geographical distance from the hospital, which necessitates physically demanding travel time. Family caregivers are ‘patients’ closest supports and can add valuable information to the assessment of symptoms and side effects,⁵ making it advantageous to have them participate in the consultation. Nevertheless, it may be challenging for family caregivers to be physically present at outpatient consultations due to work, other family obligations or geographical distance.

Various forms of telemedicine are increasingly used in healthcare, particularly after the COVID-19 crisis.⁶ The World Health Organization⁷ defines telemedicine as ‘the delivery of healthcare services, where distance is a critical factor’. It can include a range of services, for example, monitoring, treatment and communication using different technologies. Sustained efforts should be made to develop novel digital solutions that are applicable and acceptable in routine patient care in real life.⁸

When assessing patients before chemotherapy, visual assessment is particularly important. Thus, video consultations may be an option. Dinesen et al.⁹ focus on the importance of identifying groups of patients for whom telemedicine care is suitable and conclude that there is no one-size-fits-all approach for its use.

Recent research has shown that video consultations are feasible for colorectal cancer follow-up at outpatient surgical care clinics, with high patient satisfaction and few patients electing face-to-face contacts.¹⁰ Several studies have investigated video consultations for vulnerable patients receiving palliative care. A systematic, integrated review of video consultations in palliative care found several beneficial aspects for patients and their families.¹¹ However, few studies have examined how patients¹² and clinicians¹³ perceive the use of telemedicine for pre-chemotherapy evaluation, and both studies were during the COVID-19 pandemic. Thus, a knowledge gap exists in its use for acute symptom assessment in the standard workflow of cancer treatment. Moreover, recent studies have included the environmental impact of video consultations and shown that video consultations reduced travel time and costs among patients newly diagnosed with colorectal cancer.¹⁴ Similarly, Bradwell et al.¹⁵ found that staff reported reductions in carbon footprint for video consultations in a COVID-19 study.

The overall study aim was to investigate the feasibility of clinical assessment and decision of treatment readiness using video consultations before chemotherapy in a nursing outpatient clinic, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, we sought to estimate reductions in travel time for patients and environmental carbon dioxide (CO₂) emissions.

Methods

Design

This study was a parallel mixed-methods design in which qualitative and quantitative data collection occurred side-by-side¹⁶ with a focus on the qualitative data. The mixed-methods design was used to gain deeper insights into the topic.

Quantitative data from patients were collected through a short questionnaire including socioeconomic status, travel time, and distance saved by video conferencing. Qualitative data were collected in semi-structured individual interviews with a subset of the patients responding to the questionnaire and a focus group interview with oncology nurses.

The Standards for Reporting Qualitative Research was used as a guideline.¹⁷

Study population

The study population comprised of patients with gastrointestinal cancer receiving chemotherapy and would be assessed for treatment readiness before their second chemotherapy cycle. Exclusion criteria included hospital staff–assessed ineligibility for video consultations due to health status and an inability to understand Danish.

After the first cycle of chemotherapy, patients were invited by a study nurse to be included in the study. A purposive sample of eligible patients was selected for the interviews to maximize variation in participants’ age, gender and cohabitation status.¹⁸ Patients decided if their family caregivers were to attend video consultations.

In addition, the study nurse invited oncology nurses for a focus group interview. The nurses were experienced in assessing side effects and symptoms, and they were trained in using video consultations with gastrointestinal cancer patients.

Standard care

Prior to the intervention, for all patients, the standard of care for pre-chemotherapy assessment consisted of a face-to-face consultation by a nurse in the clinic the day before treatment.

Intervention

Data were collected from 1 April to 1 October 2019 at the Department of Oncology at Odense University Hospital in the nursing outpatient clinic for gastrointestinal cancer. The hospital uptake area includes 1.2 million inhabitants across roughly 12,000 mi², with several islands only accessible by boat.

The intervention consisted of nurse-conducted video assessments before the second cycle of chemotherapy, replacing the usual in-person consultations. During video consultations, nurses made the same assessments as in standard care: performance status, clinical toxicity grading, monitoring hematological and biochemical toxicity, and assessing the patient's side effects, symptoms and holistic needs. Based on this, the nurse decided whether the patient was ready for chemotherapy the following day. The patient received information about topics related to treatment, such as supportive care and blood sample results. As standard care, if the nurse assessed that the patient was not fit for treatment, the nurse contacted the leading oncologist. If the patient was ready for treatment, the video consultations continued prior to the next cycle and onward.

Technology

The video consultation took place via the application or website, My Hospital.¹⁹ After consent, participating patients and their family caregivers received brief guidance from the study nurse on how to attend the video consultation in My Hospital, and their own devices were checked. Information technology (IT) consultants at the hospital were available to patients via a telephone hotline if they experienced technical difficulties.

Semi-structured interviews

The patients were interviewed if they had at least one experience with video consultations, and the interview took place the week after. A semi-structured interview guide developed for individual interviews with patients included the following topics: introduction of the patient (and family caregiver), experience with technology, experience with video consultations and how video consultations affected everyday life. The second author conducted the interviews in person, via video, or via telephone, depending on patient preferences. Audio-recorded interviews were transcribed verbatim.

Focus group interview

The focus group interview of nurses conducting video consultations took place at Odense University Hospital. Attention was paid to creating a diverse group of participants to reduce the risks of limited interaction in overly homogeneous groups and larger disagreements in overly heterogeneous groups.²⁰ An interview guide with open questions and tasks was developed for the two-part focus group. Participants were first asked to write down three positive and three negative thoughts about video consultations. These reflections formed the basis for a discussion. Participants were then introduced to anonymized quotes from the patient interviews about video consultations. Their thoughts about the quotes formed the basis for a second discussion. The second author facilitated the focus group interview, which took place in a hospital conference room. The first author was present as an observer, taking field notes and validating the content of discussions.

All four authors are experienced oncology nurses and researchers but have no relation to any participants. Further, we had no experience with video consultations.

Survey data

A study nurse handed a short questionnaire to participants, including items about age, gender, diagnosis, educational level, distance from home to Odense University Hospital and time spent traveling to and from the hospital. The questionnaire content was inspired by other studies involving video consultations.^21,22 For patients declining to participate or for whom video consultation was not possible, data on age and reason for non-participation were collected.

Analysis

Content analysis was applied to interview and focus group data.²³ Each interview was listened to, and each transcription was read multiple times to gain a holistic sense of patients’ experiences, followed by initially noting descriptive comments. Two authors, experts at analyzing qualitative data, read the transcripts separately before discussing the data to identify codes and themes. Analytic steps identified emergent themes, patterns across emergent themes and, finally, superordinate themes (Figure 1). NVIVO 12.0 was used for content analysis to ensure the identification of data divergence and convergence.

Figure 1.

Topics and themes related to nurses’ use of video consultations for patient assessment before chemotherapy.

Questionnaire data and reasons for non-participation were analyzed descriptively with means or medians for continuous variables and frequencies for categorical variables. Statistics were calculated with STATAIC 15, and CO₂ emissions were calculated using a tool on the United States Environmental Protection Agency website (https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator). To integrate the results from the two different methods and create meta-inference, all authors met to discuss the results against the research aim and design (Figure 1).²⁴

Ethics

In compliance with the Helsinki Declaration,²⁵ all participants received oral and written information about the study and were included after providing written informed consent. Participants were informed about their right to withdraw from the study at any time. The study was registered with the Danish Data Protection Agency (no 19/8149), and the data were stored securely on a SharePoint site.

Results

Participants

A total of 119 patients were informed about video consultations, 85 (71%) agreed to participate. The planned video consultation was not possible for one patient, leaving data from 84 patients to analyse. Reasons for the 34 patients declining participation were lack of a device or internet at home 13 (38%), a planned in-person consultation with a physician or dispensing of prescribed medication requiring in-person attendance 12 (35%) or other reasons 9 (27%).

The participating patients did not differ from the non-participants in mean age (66 vs 67 years, p = 0.619) or gender (p = 0.500). Among patients, 69 (83%) were aged > 60 years and 58 (69%) were male (Table 1). More than half, 46 (57%) of the patients, had pancreatic or colorectal cancer. Most patients were cohabiting 71 (85%) and, for more than half 47 (59%), the highest educational level attained was primary school, short-cycle higher education or vocational training (Table 1).

Table 1.

Characteristics of participating patients, n (%).

		n = 84
Gender
	Male	58 (69)
	Female	26 (31)
Age in years
	Mean (SD)	66 (7.8)
	40–49	4 (5)
	50–59	10 (12)
	60–69	37 (45)
	70–79	32 (38)
Cancer site^a
	Colorectal	22 (27)
	Duodenal	2 (2)
	Liver or bile duct	12 (15)
	Gastric	10 (12)
	Esophageal	11 (14)
	Pancreatic	24 (30)
Educational level^a
	Basic school	7 (9)
	High school, short-cycle higher education or vocational training	40 (50)
	Medium-cycle higher education	28 (35)
	Long-cycle higher education	5 (6)
Cohabitation status
	Living alone or with children	13 (15)
	Cohabiting	71 (85)

Responses provided by 81 participants.

All patients avoided coming to the hospital for at least one consultation. For the 75 (89%) patients who primarily used their own car for transportation, 38 (46%) saved an hour or more of travel time and avoided traveling a median distance of 120 km (2–450 km) for each video consultation (Table 2). The total distance saved was 12,877 km, equivalent to 7018 lb of CO₂. This CO₂ emission corresponds to 387,226 smartphone charges.

Table 2.

Travel distance, time and carbon emissions saved per video consultation, compared to in-person visits.

	km saved*	Lb CO₂ saved*
Median travel distance saved, km (range)	120 (2–450)
Total travel distance and carbon emissions saved	12877	7018
	n patients per group (%)	Lb CO₂ saved* range(median)
0–50 km	38 (45)	1–53 (40)
50–100 km	21 (25)	27–214 (75)
100–150 km	14 (17)	80–160 (127)
150–200 km	8 (10)	160–214 (194)
> 200 km	3 (3)	112–240 (214)
Minutes of travel time saved	n patients (%)
0–30 min	21 (25)
30–60 min	24 (29)
60–120 min	33 (40)
> 120 min	5 (6)

*Abbreviations: km = kilometers; Lb CO₂ = (carbon dioxide or carbon dioxide equivalent) Pounds CO₂ emission.

A total of 15 semi-structured individual interviews with ten male and five female patients were conducted by telephone (n = 11), in person (n = 2) or by video (n = 2). The median age of the interviewed patients was 67 (range, 52–78) (Table 3). Individual interviews lasted 15–25 min.

Table 3.

Characteristics of 15 patients participating in interviews, n (%).

Male	10 (67)
Female	5 (34)
Age in years
50–59	3 (20)
60–69	5 (34)
70–79	7 (47)
Educational level
Basic school	1 (7)
High school, short-cycle higher education or vocational training	7 (47)
Medium-cycle higher education	5 (34)
Long-cycle higher education	2 (13)

One focus group interview was conducted with five clinical nurses, consisting of both sexes, from the outpatient clinic. They had a mean age of 42 (range, 36–45). The focus group lasted 90 min.

Themes

Five themes emerged from patient and nurse interviews. Three themes were derived from the individual interviews with patients, and two were derived from the focus group interview with nurses (Figure 1).

Patients

Impact of video consultations

Patients experienced saving many hours of public transport, by car or ferry, and outpatient clinic waiting time. Patients highly valued the option of having more time at home to finish chores, socialize with family, and do other things. As one 66-year-old man said,

‘I avoid spending two hours in the car going back and forth to the hospital, and then I also have to find parking and wait in the waiting room—often it takes the whole day’.

In addition to saving travel time, many patients found that their family caregivers had easier access to video consultations than in-person visits and could participate on equal terms. Caregivers often appeared on the screen with patients or sat in the background, adding questions and comments. In several cases, caregivers experienced being able to improve the quality of consultations with their experiences of the patient's condition, side effects from treatment and so forth. As a 66-year-old woman put it:

I don’t have to drive to the hospital, nor does my husband. By using video consultation, we have the time at home instead. Our daughter, who lives near us, came by, and also asked a few questions It was a good thing, as I do not always remember to ask about it all.

Some patients continued to work during cancer treatment and were particularly happy with virtual consultations. Moreover, several patients described not being exhausted when they went to the outpatient clinic for chemotherapy the following day.

Interviewed patients described different experiences arising from the fact that they did not have to sit in the waiting room with many other patients and their caregivers. They described the waiting room as reminding them of how sick they were. Moreover, they experienced a lot of noise and unrest in the waiting room and clinic due to the many people who were present. They felt more comfortable sitting at home, talking to the nurse in calm surroundings and getting answers to their questions. However, video consultations sometimes resulted in face-to-face consultations if patients needed extra blood tests or had symptoms that made it necessary for them to see a physician.

In general, patients appreciated being able to live their lives as normally as possible, avoiding travel and waiting time.

Patient–nurse interaction

Patients said that specific things were different in video consultations. They experienced closer and more focused contact with nurses during video consultations compared to face-to-face consultations. They believed that nurses looked and spoke more directly to them and maintained good eye contact. As a 64-year-old man said,

‘I felt that the nurse was closer than when I was physically present. I felt that she was there only for me and that she was very present’.

The patients described how they talked about difficult topics, such as the decision to stop treatment or the progression of illness, in the video consultation. Most patients preferred a face-to-face consultation in such instances. However, some patients had a different perspective:

You could say that if the message is serious, it is probably best to be physically present with the nurse in the hospital. Then we can see each other's body language and such … but otherwise it will also be very safe and comfortable to sit at home in the living room with my husband and daughter and get a serious message - we can talk about it afterwards in peace and quiet without having to go on a long drive first. (Woman, 66 years)

Several patients reported that it was important that they had been physically present in the outpatient clinic before using video consultations. All interviewed patients expressed that the most important thing was continuity, that is, that a nurse they knew or had seen before held the consultation. It helped them feel secure and confident. As a 59-year-old man described it,

‘I knew the nurse from the first treatment. We did not have to start all over again. She knew me, my disease and my treatment’.

Patients generally experienced presence, confidence and intimacy in many ways during video consultations.

Patient handling of technology

Several patients received help from family caregivers when they connected to the virtual meeting room and logged into the consultation. Some patients and their caregivers were a little nervous about whether it was going to work. A 72-year-old man said:

I have not tried anything similar before, and I don’t really understand that kind of thing. My wife is better at handling technology so she did it for me. We were a little nervous, especially my wife, wondering if it would all work out right, but it did – thankfully.

Other patients had used similar solutions in work contexts and had no worries about the technology. They simply followed the instructions.

Most participants experienced good image and sound quality during video consultations, which were important to their overall experience. Participants had been provided a telephone number for IT support, available every weekday if problems arose. Similarly, all patients who were unsure about the connection quality were informed to make a test call to IT support. A 64-year-old man experienced good image and sound quality:

I made a test call for IT support before the consultation. On the day of the conversation, the picture was clear to me. I could see the nurse very clearly, and the sound went through - it was as if the nurse was sitting right next to me.

A few participants who used smartphones for video consultations noted that the video image was too small to see details and subsequently used a tablet or computer. Patient participants also described a need to learn how to hold a tablet or phone to get the best picture.

Some patients experienced technical problems. The sound disappeared, or the image became distorted or disappeared. Occasionally, the rest of the conversation was conducted by telephone. A 62-year-old man described these issues:

I have experienced that it can fluctuate during the conversation, so the quality is good, and then it is bad. For example, I experienced that after a few minutes, the sound disappeared and then the picture. We had to take the last part of the consultation over the phone. I was just glad I didn’t have to drive the long way to the hospital.

For the few patients who experienced technical problems, they were inconsequential. It was more important that they avoid travel.

Nurses

Assessment of symptoms using technology

Participating nurses were frustrated when the technology did not work well. Technical issues took away their focus from the consultation and made it difficult to carry out pretreatment assessments, leading to feelings of professional inadequacy and uncertainty. Assessments consisted of inquiring about side effects, including fatigue, pain, malaise and general well-being, and relying on visual information, such as evaluating patients’ skin for redness, dryness and possible peeling. A 45-year-old nurse described the effect of technology problems:

If the technology causes problems, then it takes focus from the conversation itself - it takes focus from what we really need to do; to assess side effects and how the patient really is. We should be able to assess their skin, but when the image quality is poor, it is not possible. Then we hope for the best and let them come for treatment the next day – it is not good.

However, all nurses reported receiving good support from clinical IT staff, who were available for questions and could help address problems with equipment, sound loss, image quality and connection. For the first few months, an IT support person was present outside the door during consultations in case nurses needed help.

Some patient participants had older equipment, that is, an older smartphone, tablet or PC without updates or a slow internet connection, which caused video images and sound to deteriorate. Nurses sometimes felt that patients would have to buy new equipment to participate in the next consultation. This was a difficult situation, as a 43-year-old nurse described:

We sometimes find that patients will have to spend a lot of money on a new tablet or a smartphone because they don’t have the equipment to get the app; their equipment is too old and they feel pressured to buy new - I don’t think we should do that, it is a slippery slope.

Consequently, study procedures were changed to disregard video consultations if patients’ equipment was old, if their internet connection was poor or if they wanted in-person consultations for other reasons.

Providing nursing care by screen

Even when the technology worked well and the image and sound were satisfactory, nurses felt that they had to ‘rethink their nursing’. It felt different to practice nursing on a screen. A 42-year-old nurse said:

We are used to act in situations - give them a napkin, a hand on the shoulder…. We need to be nurses in a different way. I think it is a bit impersonal. Maybe I am blocking myself there. I think it makes a huge difference whether I have a patient sitting across from me or there is a screen.

Other nurses found that video consultations lacked the casual conversation usually present in physical consultations and the ability to see the whole patient and get an overall impression of their condition. For example, a 45-year-old nurse said,

‘You also don’t see everything we see when we fetch the patient in the waiting room on the way to the consultation room. There, you make two or three observations, which we lack in the video consultation’.

Conversely, participating nurses were also very aware that video consultation was a whole new concept, and they had to learn to use it and see the screen as a ‘co-player’. They also described the benefits of video consultations. Nurses experienced happier patients who had not used all their energy to get to the hospital the day before treatment, which they saw as a significant gain. They also found that patients were happy not having to spend time in the waiting room and avoiding travel time and parking, which is consistent with what participants described. A 42-year-old nurse said:

It was strenuous for the patients to come TWO days in a row. For a long time, we have been thinking about how we could do it better, and now we are accommodating this with video consultations. The patients are happy. They feel that they have us alone and close. They experience presence, and most importantly, they do not have to spend time on transportation. Most patients are also more relaxed when sitting at home in a familiar environment.

The nurses had always encouraged family caregivers to join conversations. Caregivers had to take time off from work to be present at in-person clinic visits. Using video consultations, they could attend from home or log in from work.

Discussion

In general, patients and nurses were satisfied with the use of video consultations. However, nurses had a few points of criticism. Both patients and nurses believed that video consultations saved time and energy for patients and mentioned the advantage of patients avoiding the waiting room with exposure to other sick and vulnerable people and the risk of infections. Most patients and nurses felt that video consultations provided closer and more focused contact. Although some patients experienced technical problems, they were still happy with the solution. In contrast, nurses believed that consultation quality suffered when technology did not work well, leading to feelings of professional inadequacy. Patients and nurses both stressed the importance of IT support. Nurses also described a need to rethink their nursing practices, particularly when they had to evaluate symptoms via screen images. This aligns with research findings that nurses use a range of compensatory mechanisms to enhance patient care when video constrains the delivery of presence.²⁶

From a clinical perspective and as reported by participating nurses, the most important thing is whether the quality of clinical assessment is satisfactory with video consultations. A randomized controlled trial among patients with prostate cancer used efficiency as a primary endpoint, finding that video consultation and hospital visits were equivalent.²⁷ Future research should focus on quality parameters suggested by patients and nurses, whose priorities extend beyond efficiency.

Almost half of the interviewed patients saved an hour or more on travel time. For a vulnerable group of patients with cancer, video consultations enabled more time at home and conserved energy for chemotherapy the following day. Patients could maintain a more normal life, including being able to work. This finding broadly supports other studies linking telehealth interventions to increased or equivalent quality of life compared to in-person visits.²⁸ However, we did not include a quality-of-life measure or ask patients if they preferred virtual consultations to in-person clinical visits for future follow-up. Previous studies support our finding that patients expressed a more evident preference for video consultations than participating nurses did. For example, patient preferences for video consultations were almost twice as high as those of physicians.²⁹

Telemedicine has been mentioned as contributing to positive climate change. The many travel miles saved in this study resulted in reduced carbon emissions, which presumably outweighed the carbon footprint of virtual consultations. However, we did not assess the carbon footprint of network data transfer or patient and nurse video equipment.³⁰ Previous studies found a low carbon footprint for telemedicine equipment compared to emissions savings from reduced travel.³¹ The mean CO₂ saved per person in our study was slightly lower than for a Scottish group of colorectal patients; however, fewer average miles were saved per patient in our study.¹⁴ Future studies should also include the environmental impact of using telemedicine in clinical practice.

Patient participants in our study reported that avoiding travel to the clinic conserved their energy and made their conversations with nurses more focused. This result supports previous findings that video consultations can be an important alternative to face-to-face consultations for this group of patients.³² Furthermore, patients in our study found value in avoiding the hospital waiting room, reducing their risk of hospital-acquired infections. The current COVID-19 pandemic has rapidly introduced video consultations because many patients and family caregivers have not been permitted to enter hospitals. Patients were satisfied with a video consultation for pre-chemotherapy evaluation in the initial phase of the pandemic, as in our study.¹² However, they were more accustomed to in-person visits and often preferred them.¹² A mix of in-person visits and video consultations during cancer treatment may offer the benefits of both options.

Based on the positive results, video consultations are now implemented as standard care in the gastrointestinal team and offered to patients after individual clinical judgment. To optimize video-assisted pre-assessment care, we need to constantly focus on technical improvements but also education in caring by screen. We plan to expand the service to other diagnostic teams, but disappointingly, some resistance exists among the professionals, and it is an ongoing cultural effort to implement new care strategies.

Strengths and limitations

This study had a number of strengths. We included the perspectives of both patients and nurses and achieved data saturation. Further, we included the larger societal perspective on travel distance, time saved, and CO₂ emissions. Our response rate was high among a vulnerable population. Moreover, our study was conducted in 2019 before the COVID-19 crisis when experience with video consultations and related technology was less developed and awareness and acceptance by both patients and clinicians were less mature.³³ According to a scoping review from 2023, telehealth and digital health were rare in routine oncology care before the COVID-19 pandemic.³⁴ Despite these challenges, we managed to include 85 patients and carry out video consultations with 84 participants at least once in a busy clinical environment. As there has been a rapid acceleration in remote cancer-care delivery due to the pandemic, a similar study carried out in the aftermath of COVID-19 would not have the same innovative character.

Most patients participated in a single video consultation before being interviewed. We did not measure patients’ and nurses’ preferences for video versus face-to-face consultations, which is a limitation. In addition, a few patients experienced technical problems, but we did not systematically assess their occurrence. Future research should monitor this. Furthermore, we did not systematically include family caregivers for interviews, which is a limitation because cancer is a family affair.³⁵ However, caregivers were invited to participate if the patient preferred this.

Conclusion

Patients with gastrointestinal cancer experienced more energy and felt comfortable using video consultations. Video consultations are beneficial for patients and reduce CO₂ emissions. However, providing an optimal clinical assessment leading to a decision of treatment readiness before chemotherapy requires testing patients’ equipment as well as technical skills and new nursing care competencies. Future research should include randomized controlled trials with quality parameters as primary endpoints.

Footnotes

Acknowledgements

The authors wish to thank the participants for their valuable contributions. They also thank the clinical nurses on the gastrointestinal cancer team. Further, they wish to thank Jennifer Green for language editing.

Contributorship

KBD and LVV conceived the study, the protocol development, gaining ethical approval, and LVV handled the patient and nursing recruitment and data collection. PKM and LKT were included in the analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

The study was registered with the Danish Data Protection Agency (no 19/8149).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Guarantor

KBD

ORCID iD

Karin Brochstedt Dieperink

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