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Communication Modality (CM) Among Veterans Using National TeleOncology (NTO) Services
Background
We examined characteristics of Veterans receiving care through NTO and their CM (e.g., telephone only [T], video only [V], or both [TV]). Relevant background: In-person VA cancer care can be challenging for many Veterans due to rurality, transportation, finances, and distance to subspecialists. Such factors may impact care modality preferences.
Methods
We linked a list of all Veterans who received NTO care with Corporate Data Warehouse data to confirm an ICD-10 diagnostic code for malignancy, and to define the number of NTO interactions, latency of days between diagnosis and first NTO interaction, and demographics. The Office of Rural Health categories for rurality and NIH categories for race were used.
Data analysis
We report descriptive statistics for CM. To compare differences between Veterans by CM, we report chi-squared tests for categorical variables and ANOVAs for continuous variables.
Results
Among 13,902 NTO Veterans with CM data, most were V (9,998, 72%), few were T 2% (n= 295), and some were TV 26% (n= 3,609). There were statistically significant differences between CM in number of interactions, latency between diagnosis and first NTO interaction, age at first NTO interaction, sex, race, rurality, and cancer type. Veterans diagnosed with lung cancer were more likely to exclusively use T. Veterans with breast cancer were more likely to exclusively use V. Specifically, T were oldest (mean age = 74.3), followed by TV (69.0) and V (61.6; p < .001). Women were most represented in V (28.3%) and Rural or highly rural residence was most common among T users (54.6%), compared to V (36.8%) and TV (43.0%; p < .001). Urban users were more prevalent in the TV group (61.9%) than in the T only group (45.4%).
Implications
We identified differences in communication modality based on Veteran characteristics. This could suggest differences in Veteran or provider preference, feasibility, or acceptability, based on CM.
Significance
While V communications appear to be achievable for many Veterans, more work is needed to determine preference, feasibility, and acceptability among Veterans and their care teams regarding V and T only cancer care.
Background
We examined characteristics of Veterans receiving care through NTO and their CM (e.g., telephone only [T], video only [V], or both [TV]). Relevant background: In-person VA cancer care can be challenging for many Veterans due to rurality, transportation, finances, and distance to subspecialists. Such factors may impact care modality preferences.
Methods
We linked a list of all Veterans who received NTO care with Corporate Data Warehouse data to confirm an ICD-10 diagnostic code for malignancy, and to define the number of NTO interactions, latency of days between diagnosis and first NTO interaction, and demographics. The Office of Rural Health categories for rurality and NIH categories for race were used.
Data analysis
We report descriptive statistics for CM. To compare differences between Veterans by CM, we report chi-squared tests for categorical variables and ANOVAs for continuous variables.
Results
Among 13,902 NTO Veterans with CM data, most were V (9,998, 72%), few were T 2% (n= 295), and some were TV 26% (n= 3,609). There were statistically significant differences between CM in number of interactions, latency between diagnosis and first NTO interaction, age at first NTO interaction, sex, race, rurality, and cancer type. Veterans diagnosed with lung cancer were more likely to exclusively use T. Veterans with breast cancer were more likely to exclusively use V. Specifically, T were oldest (mean age = 74.3), followed by TV (69.0) and V (61.6; p < .001). Women were most represented in V (28.3%) and Rural or highly rural residence was most common among T users (54.6%), compared to V (36.8%) and TV (43.0%; p < .001). Urban users were more prevalent in the TV group (61.9%) than in the T only group (45.4%).
Implications
We identified differences in communication modality based on Veteran characteristics. This could suggest differences in Veteran or provider preference, feasibility, or acceptability, based on CM.
Significance
While V communications appear to be achievable for many Veterans, more work is needed to determine preference, feasibility, and acceptability among Veterans and their care teams regarding V and T only cancer care.
Background
We examined characteristics of Veterans receiving care through NTO and their CM (e.g., telephone only [T], video only [V], or both [TV]). Relevant background: In-person VA cancer care can be challenging for many Veterans due to rurality, transportation, finances, and distance to subspecialists. Such factors may impact care modality preferences.
Methods
We linked a list of all Veterans who received NTO care with Corporate Data Warehouse data to confirm an ICD-10 diagnostic code for malignancy, and to define the number of NTO interactions, latency of days between diagnosis and first NTO interaction, and demographics. The Office of Rural Health categories for rurality and NIH categories for race were used.
Data analysis
We report descriptive statistics for CM. To compare differences between Veterans by CM, we report chi-squared tests for categorical variables and ANOVAs for continuous variables.
Results
Among 13,902 NTO Veterans with CM data, most were V (9,998, 72%), few were T 2% (n= 295), and some were TV 26% (n= 3,609). There were statistically significant differences between CM in number of interactions, latency between diagnosis and first NTO interaction, age at first NTO interaction, sex, race, rurality, and cancer type. Veterans diagnosed with lung cancer were more likely to exclusively use T. Veterans with breast cancer were more likely to exclusively use V. Specifically, T were oldest (mean age = 74.3), followed by TV (69.0) and V (61.6; p < .001). Women were most represented in V (28.3%) and Rural or highly rural residence was most common among T users (54.6%), compared to V (36.8%) and TV (43.0%; p < .001). Urban users were more prevalent in the TV group (61.9%) than in the T only group (45.4%).
Implications
We identified differences in communication modality based on Veteran characteristics. This could suggest differences in Veteran or provider preference, feasibility, or acceptability, based on CM.
Significance
While V communications appear to be achievable for many Veterans, more work is needed to determine preference, feasibility, and acceptability among Veterans and their care teams regarding V and T only cancer care.
Transportation as a Barrier to Colorectal Cancer Care
PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.
BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.
METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.
DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.
RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.
IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.
PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.
BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.
METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.
DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.
RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.
IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.
PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.
BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.
METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.
DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.
RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.
IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.