Enhanced Telehealth in Prostate Cancer

Importance: Prostate cancer often requires frequent in-person clinical visits, imposing substantial travel, financial, and time burdens for patients. Combining telehealth with in-home monitoring (enhanced telehealth) has the potential to make care more patient centered and efficient. Objective: To assess the feasibility and implementation context of enhanced telehealth for patients with prostate cancer. Design, Setting, and Participants: Adult patients with prostate cancer receiving androgen deprivation therapy (ADT) were enrolled in this multiphase quality improvement study of enhanced telehealth from June 1, 2023, to June 30, 2024, and followed up for 8 months. The study was conducted at 7 ambulatory oncology practice sites at Memorial Sloan Kettering, an academic comprehensive cancer center. Phase 1 included semistructured interviews with key stakeholders to assess implementation considerations of enhanced telehealth. Phase 2 piloted an enhanced telehealth program offering remote blood pressure (BP) monitoring, mobile phlebotomy, and injections at home; patients could choose to participate in any available component. Intervention: Enhanced telehealth, a care delivery model that augments routine telehealth encounters with (1) home phlebotomy, (2) remote BP monitoring, and/or (3) at-home administration of ADT or other injectable therapies. Main Outcome and Measures: The primary outcome was feasibility, assessed by completion rates for each enhanced telehealth component at the patient and visit levels. Patient and clinician satisfaction was assessed using the Net Promotor Score. Acceptability, appropriateness, and feasibility were measured using validated measures on a 5-point Likert scale. Results: Thirty-eight patients participated; the median age was 70.0 years (IQR, 61.5-76.7 years) and 24 (63.2%) had metastatic castration-sensitive prostate cancer. Patient-level completion rates for at least 1 service were telehealth, 68.4% (26 of 38); remote BP monitoring, 91.9% (34 of 37); home phlebotomy, 96.3% (26 of 27); and at-home injections, 90.0% (9 of 10). Visit-level completion rates were high for telehealth (92.3% [60 of 65]), phlebotomy (95.4% [145 of 152]), and injections (84.6% [11 of 13]) but lower for BP monitoring (65.0% [343 of 528]). Patients rated all components as acceptable (mean [SD] score, 4.8 [0.4]; range, 3.25-5), appropriate (mean [SD] score, 4.8 [0.4]; range, 3.75-5), and feasible (mean [SD] score, 4.7 [0.5]; range, 3.25-5). Enhanced telehealth had high patient and clinician satisfaction (Net Promotor Score: patients, 82.4%; clinicians, 80.0% for telehealth, 80.6% for remote BP monitoring, 84.6% for home phlebotomy, and 75.0% for home injections). Conclusions and Relevance: In this quality improvement study, enhanced telehealth was feasible, with greater than 60% completion for all scheduled visits, with strong endorsement of benefits from patients with prostate cancer as well as clinicians. These findings support further development of enhanced telehealth.