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Background

Gynecologic cancers are among the most prevalent cancers in women, yet many patients do not receive guideline-concordant care, in part due to lack of geographic access to gynecologic oncologists (Gyn Onc). Telemedical technology allows patients' local physicians to consult with subspecialist Gyn Oncs, without burdening patients with unnecessary in-person visits. Providers' acceptance of provider-to-provider telemedicine consultation for the management of gynecologic cancers is unknown. We aimed to gather feedback about experiences with referrals, communication, and openness to telemedical consultation between Gyn Oncs, gynecologists (Gyn) and medical oncologists (Med Onc).

Methods

Gyn Onc, Gyn, and Med Onc physicians were recruited from practices serving rural patient populations to participate in semi-structured interviews. As implementation of telemedicine interventions is influenced by factors at multiple levels, the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) guided the interview. Questions focused on barriers and facilitators to provider-to-provider telemedicine consultation stemming from inner/outer settings and individual experiences. Interviews were conducted via WebEx, recorded, and transcribed. Two coders established analytic reliability with two transcripts and independently coded remaining interviews using a combined CFIR-TDF framework. Codes were analyzed and combined into salient themes.

Results

We conducted 11 interviews (6 Gyn Onc, 3 Gyn, 2 Med Onc). We identified six themes, including hesitancy to adopt new methods of communication, frustration with existing methods, and potential gaps that could be filled by a cloud-based asynchronous platform.

Conclusions

Providers experience burnout from communication and are hesitant to adopt a new platform. Providers note referrals with providers using different EHR systems are difficult, as they cannot share patient records easily and securely. Providers are open to adopting provider-to-provider telemedicine consultation if the system can be streamlined to share patient records easily.

Read an interview about the study here.