Introduction
Methods
Participants
Data collection
Data analysis and reduction
Results
Participants and session characteristics
Participants (n = 11) | |
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Demographics | |
Age, mean years +SD | 58.5 + 8.7 |
Male, n (%) | 7 (63.6) |
Canada/USA, n (%) | 7 (63.6)/4 (36.4) |
Telehealth SLP sessions per participant | |
Telehealth via A/V, n (%) | 8 (73%) |
Telehealth via phone + A/V, n (%) | 2 (18%) |
Telehealth via phone only, n (%) | 1 (9%) |
Interview sessions per participant | |
Time between last telehealth session and interview, mean months +SD | 4.9 + 2.5 |
Length of interview, mean minutes +SD | 19.6 + 7.0 |
Participant perspective regarding telehealth
Topic areas | Code category(s) | Definition | Key message (themes) summarized from participant viewpointa |
---|---|---|---|
What were the telehealth SLP sessions like? | Description of the telehealth session | Factual account of what happened during the session | The SLP watched my swallowing, then demonstrated the exercises or discussed the food chart and answered any questions I had. Sessions did not require much preparation and it was more informational. |
Participant expectation of PRO-ACTIVE telehealth session | What participant thought might happen during the session before the first telehealth session occurred | Overall I thought the idea of using telehealth was great when I heard about it, but I wasn’t sure what to expect at my session. | |
Participant evaluation of PRO-ACTIVE telehealth session | Participant’s summative evaluation of the session/satisfaction; experience of using telehealth as a mode of care delivery | I felt satisfied and comfortable after the sessions. They worked well, were easy to follow, and I received clear instruction and guidance. | |
Participant outcomes from PRO-ACTIVE telehealth session | Participants’ expressions of confidence and accomplishment at end of session/learning | I learned what I needed to learn and felt confident doing it on my own afterwards. | |
What worked well for telehealth SLP therapy sessions? | Facilitating factors of telehealth | What helped with participating in the telehealth sessions i.e. things (factors) that made it easy? | I’ve used teleconferencing before, for work and for medical appointments, and am quite comfortable with the technology. It was a huge plus to have a caregiver present and have an engaging and responsive clinician lead the telehealth sessions. |
What did not work for the telehealth SLP sessions? | Limitations in using telehealth | Perceived limitations in using telehealth as a mode of care delivery) | Possible limitations could be if I was not very technical as far as computers are concerned or did not have any previous experience receiving health care via telehealth. |
Barriers in using telehealth | Perceived barriers in using telehealth as a mode of care delivery – things that stopped or prevented the session from happening | Severe swallowing deficits, or having a lot of symptoms, or experiencing technical glitches, may possibly make telehealth more difficult for some patients. | |
Drawbacks of using telehealth | Negative effects in using the telehealth approach | Teleconferencing does not allow for a close examination of the mouth and the throat and there is just a little something missing in these sessions that doesn’t allow for the nuances of an in-person session or an interpersonal connection. | |
Participant concerns about telehealth | Participant worries or concerns about the telehealth approach | I was concerned about problems with my internet connection and whether the therapist could really see how I was swallowing or doing the exercises. | |
How does telehealth compare to in-person SLP sessions? | Comparing between in person and telehealth sessions | How did participants compare their in person with telehealth sessions | Telehealth sessions were comparable with no real difference to in-person sessions and just as effective. It did not compromise what I learned when compared to live sessions. |
Participant perception about having video option for PRO-ACTIVE telehealth session | Participants’ specific comments about having the video option | Video conferencing is better than telephone because it allows the therapist to show how to execute the exercises and to give patients feedback on those. | |
Benefits of using telehealth | Overall benefit of using telehealth | Benefits of using telehealth sessions as a mode of cancer care delivery | Convenience is a big factor. The telehealth sessions saved commuting time, and I wasn’t exhausted from it. It allowed having someone else participate and not wasting their time. |
Benefits of using telehealth during COVID | Benefits of receiving care using telehealth during COVID | During COVID, it was a super positive experience because every time I would go to the hospital for radiation or whatever, there was always a potential chance of meeting or interfacing with somebody who could contaminate me. | |
Suggestions to improve telehealth experience and optimize overall healthcare delivery | Suggestions to improve telehealth session | Specific suggestions or recommendations by the participants to improve telehealth sessions | Video works better than telephone. Also suggest using a video conferencing platform that is easy to use and allows recording of the sessions. |
Suggestions to improve overall PRO-ACTIVE SLP care delivery | Suggestions to improve overall PRO-ACTIVE SLP care delivery not related to telehealth or COVID | There isn’t anything to improve; the only suggestion is to ensure easy access to individual patient test result details and therapy instructions. | |
Potential for future telehealth applications | Participant suggestions for implementing telehealth in areas of health care delivery in future | Use telehealth for team meetings with patients to make communication more efficient and improve care. |
Key message 1: what were the telehealth SLP therapy sessions like?
We were going through every exercise while I was doing it. I would have water, different types of food; she would watch me eat and swallow and be able to give me pointers” [PT-06].
I was excited because it made my life a little bit easier [PT-11.].
I felt confident that I was doing the exercises as they were intended. And that I was, you know, informed on how to go ahead with how to eat certain foods as the food pyramid illustrated [PT-02].
Key message 2: what worked well for telehealth SLP therapy sessions?
I work in the technology industry, most of my conferences or calls or daily interactions with customers and or whatnot was through either a phone call video conferencing, so speaking to a medical professional wasn’t any big deal. [PT-08].
I could put him [the caregiver] on speaker and he could participate, because he would help me ask questions or sometimes, you know, he can see my face [if] I didn’t understand. So he would say, Are you sure you understand you ask the question again, and so we can help clarify. So it was, it was really good way to have your support there. So that was a huge plus. [PT-04].
I have one office downtown [and] I work from home. I already have my laptop, I bring [it] home all the time and I have good internet connection here. So I didn’t have to upgrade anything in terms of software or fiber or I don’t know my system. [PT-07].
Key message 3: what did not work for the telehealth SLP sessions?
I’m not very technical as far as computers are concerned [PT-05].
The one time we were having issues, it would freeze up. So everything was kind of chattering. So you would kind of have to wait. So that was a little frustrating [PT-06].
I really didn’t have a lot of negatives, the only thing is instead of just being telephone, instead of just being voice, it should also be video.[PT-04].
Key message 4: how does telehealth compare to in-person SLP sessions?
Effectiveness, I don’t, I don’t know if there’s a compromise in either way. I think, I like to think that they’re effectively getting the results that you’re looking for both ways. [PT-01].
[It] makes you feel better seeing them in person that way they can say, “Oh, it looks so good. And you’re doing well”. Yeah, they said the same thing when I talked to them [SLP] on the phone, but seeing somebody makes a difference, I guess. [PT-09].
As far as instruction about the exercises, who to keep working with, that was you know, on par with in clinic. I would say for both in clinic and the telehealth, you’re capturing it all. [PT-10]
Key message 5: benefits of using telehealth
I think [the sessions] can be handled more efficiently actually, by the telehealth, like the commute, reducing the risk of getting COVID, having someone else participate and not wasting their time. All three big benefits of having it done through a virtual meeting [PT-07].
I was excited because it made my life a little bit easier, not having to drive to go to a visit. That we could do it from wherever, usually it was work, which made it easier. So all in all, I thought [it] was very beneficial for me to do that instead of going to in person [PT-11].
It was a huge help in keeping me participating without having to use a lot more energy or having to, you know, drive down there. You know, walk through all the washing hands and getting masks and you know what it was just like in the COVID environment, it was a huge relief. So for me, it was good. [PT-04].
Key message 6: suggestions to improve telehealth experience and optimize overall healthcare delivery
Again, it depends on the study, but on this research that requires some exercise to be able to maintain your ability to swallow. I think video would have improved it. [PT-04].
Yeah, actually might be, or as the exercises go, you can replay the session and actually redo the session, have the session available to you to redo to review the exercises again, because when we think we remember, well, I’ve had some past experience of what we think we remember and you’re tested on it for a period of time, it’s not exactly the same. Being able to replay the session would be, I think, a benefit [PT-10].
I could see it being beneficial, having, you know, the different specialists in the same meeting so that they could compare notes and possibly bounce ideas off each other as well. So I guess just a sidebar note on how well teleconferencing can work in the health care sector [PT-02].