Study Finds Telehealth Consultations Provide Same Level Of Shared Decision-Making As In-Person Visits

A large observational study conducted by researchers at Vanderbilt University Medical Center has discovered that patients receiving a first-time surgery consultation via telehealth and those receiving it in person experienced the same level of shared decision-making. The findings of the study were recently published in the American College of Surgeons’ journal and were funded by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) and the National Center for Advancing Translational Sciences (NCATS).

Telehealth (or telemedicine) has become a widely utilized and accepted form of patient care. The Covid-19 pandemic has spurred a change towards virtual telehealth meetings with surgeons. Despite the potential advantages that this method of healthcare provisioning may hold for both patients and surgeons, the degree of quality contained in these consultations has yet to be explored.

“We see patients that live hours away. When the COVID-19 pandemic hit, it threw fuel on the fire of our telehealth program,” said study co-author Alexander T. Hawkins, MD, MPH, FACS, associate professor of surgery at Vanderbilt University Medical Center in Nashville, Tennessee. “Across the entire healthcare system, we now do about 20,000 telehealth visits a month. Previously, there had been concerns about whether we could effectively communicate with patients remotely, but we found that patients are just as satisfied with telehealth visits as in-person appointments.”

The Vanderbilt University researchers conducted the comparative study assessing the quality of shared decision-making and communication between video appointments and in-person visits in 387 patients visiting general surgery clinics at Vanderbilt University Medical Center in Nashville between May 2021 and June 2022. Participants were divided into two categories based on their visit type: in-person or telehealth. 301 people participated in an in-person visit, while 86 opted for a telehealth consultation. Both of the groups had similar characteristics in terms of age, gender, job status, and level of education. 

The researchers utilized a validated questionnaire called the collaboRATE Top Box score in order to evaluate the level of shared decision-making. Additionally, the 9-item Shared Decision-Making Questionnaire was conducted to measure patient satisfaction. Furthermore, an analysis of responses to open-ended questions about visits from both patients and surgeons was done. The researchers hypothesized that telehealth would be less effective than in-person consulations.

The report’s findings indicated that both groups of patients reported positive levels of communication during their visits. An adjusted analysis was conducted to assess how shared decision-making and communication quality were similar in both remote and in-person care. The results showed that telehealth was not inferior to in-person visits when it came to satisfactory communication. Patients had mixed reactions to their telehealth experience; many found it to be convenient and beneficial, while others pointed out the difficulties of not being able to be physically present and technical issues. The researchers acknowledged that telehealth visits do not offer the same standard of care as an in-person physical examination, and thus may not be the most suitable choice in all cases. Some surgeons believe that Telehealth should be employed for follow-up appointments with a familiar patient, rather than for initial consultations.

“We believe these results suggest that either method, in-person or telehealth, is appropriate. Ultimately, it very much depends upon what the surgeon and the patient think is the best way to communicate,” Dr. Hawkins said. “Going forward, we need to determine what is most appropriate for telehealth, and what is most appropriate for in-person visits. The data we generated in this study do give folks support, so that if they prefer telehealth appointments, they can be confident that they will not be sacrificing quality of communication or shared decision-making.”

The researchers identified some key limitations to the study, however, including a greater than 50% non-response rate and the majority of participants were based in middle Tennessee, southern Kentucky, and northern Alabama. Consequently, these results may not be applicable to other areas or varied demographics. The research team will now focus on conducting further research to form a condition-by-condition guide of when telehealth should be used, like hernia surgery that requires a physical examination. The researchers hypothesize that telehealth may be a possible solution for other patients who just require follow-up care for routine operations.