COVID-19 and information and communication technology in radiation oncology: A new paradigm

Table 1 Barriers to implementing remote consultations

Technological barriers
Availability of smart phones or mobile devices
Mobile network coverage
Lack of a dedicated, properly-equipped office in the hospital to conveniently and rapidly program and conduct a remote visit that is comparable to a real-life consultation. This equipment would include videoconferencing software to allow for a proper anamnesis, with hands-free headphones to allow the physician to record data on the eMR, and automatic telephone dialling
Electronic medical record formats and the capability to order complementary tests through the software
Physical barriers
Telephone consultation and difficult anamnesis in some cases, such as patients with a laryngectomy, cognitive impairment, hearing loss, neurological diseases, or poor language skills (i.e., foreigners), etc;
Impossibility of performing a correct physical examination of patients
Communication barriers
Physicians
Use of technical jargon
Semantic barriers: Inability to understand the language used by the sender or the receiver
Lack of body language signals (telephone consultations)
Potential lack of empathy in telephone consultations
External interruptions
Patients
Mental (“not thinking clearly”) and emotional blocks
Fear of asking questions
Lack of family support during the teleconsultation
Potential misinterpretation of the message
Feelings of inferiority
Misinformed or “overinformed” (infodemia)
External interruptions
Difficulties in understanding how to behave in this unique setting: Respect, cordiality and a collaborative attitude
Psychological barriers
Physicians
Feelings of insecurity due to work processes outside of routine practices;
Perceived deterioration in the doctor-patient relationship, in which it is necessary to cede more power and autonomy to the patient with more open dialogue (and a less paternalistic relationship)
The need to use an appropriate tone of voice, ask clear and concise questions, use warm and friendly language, and practice active listening when communicating with patients
Potential to perceive a certain loss of humanity due to the lack of physical presence
Patients
If the patient cannot see the physician (e.g., telephone call), this can produce feelings of depersonalization
The patient may be accustomed to letting the physician make health-related decisions
The patient may have difficulties describing symptoms in a virtual setting
Bioethical barriers
Confidentiality and privacy
Data protection
The remote consultation cannot replace a face-to-face visit, but rather complements it
Risks related to computer security and hacking

Table 2 Areas to target for improvement and improvements specific to radiation oncology

Areas to target for improvement
Specific agenda only for remote consultations that is separate from face-to-face consultations
Ensure that video-assisted consultations include automatic dialling, headphones, a camera and a microphone
Implementation of electronic prescriptions
Ability to directly order complementary tests telematically
Possibility of sending notifications and reminders to the patient's mobile phone
Health care education and promotion directly from primary care
Increased digital literacy in the general population
Computer security measures
Provision of technology in rural areas: Mobile coverage, access to devices, etc
Remote consultations considered as a complement to face-to-face visits
Emotional support for the patient, family involvement, motivation and commitment
Provide legal safeguards for these tools
Improvements specific to radiation oncology
Regulation of remote work (“work from home”) options in the radiation oncology. For example, it would be feasible to work from home one day each week to perform remote contouring or other work that does not require a physical presence. Working from home should be considered a natural extension of our work, although potential disadvantages must be considered: Failure to disconnect from work, lack of clarity regarding work organization, and difficulties in the work-life balance
To apply Big Data in our work, we need appropriate electronic medical records and data reporting formats that provide us with feedback on our results, which can then be used to improve clinical care