How Equity and Quality Are Considered by Cancer Centers Offering Practice-Integrated Telehealth Visits: A Qualitative Study

Abstract

INTRODUCTION: The COVID-19 pandemic forever changed health care delivery and led to a rapid uptake in telehealth visits. However, the quality and equity of these visits compared to in-person visits are unknown. This analysis interviewed oncology practitioners to understand how US-based cancer centers considered care quality and equity in the implementation and sustainability of telehealth programs. METHODS: This qualitative study employed semistructured interviews to explore practitioners' experiences and perceptions regarding care equity and quality within integrated telehealth services. Primary data collection occurred through interviews conducted between October 2021 and January 2023. These interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. RESULTS: Four main themes, representing interviews with 39 professionals from 16 organizations, were identified: 1) organization-level diversity, equity, and inclusion (DEI) efforts remained conceptual and disconnected from oncology telehealth services, 2) equity and quality-related actions were predominately reactive rather than proactive, 3) equity was misinterpreted as providing equal care to all patients, and 4) telehealth quality and equity were not systematically measured or prioritized. DISCUSSION: These findings highlight how organizational DEI efforts did not translate to tangible operational practices in oncology telehealth care. These results suggest limited organization DEI maturity and practice-level accountability for equity and quality and a lack of understanding of equity. CONCLUSION: To deliver high-quality and equitable oncology telehealth, cancer centers and other health care organizations must progress beyond awareness of equity issues. They need to implement concrete resources, support systems, and policies that facilitate effective strategy execution.