The veterans affairs health care system national teleoncology service: veteran and provider perspectives and experiences

Figures & data

Figure 1. Study flow for veteran participants.

Table 1. Participant key quotes.

CFIR domain: construct	Veteran quotes	Provider quotes
Intervention Characteristics: Relative Advantage	It’s very important because rather than having to go to [HUB SITE NAME REDACTED] to sit down and see a doctor for 10–15 min, you can stay home and not have to worry about getting into the traffic and all that. And you can get the same information over the phone through telecommunications that you would by going to [HUB SITE NAME REDACTED] … That has been a plus – especially back during the pandemic. The advantage for me is to see her. That would be the advantage to me. It doesn’t make it … any less real over the phone, but it makes it more comforting for me to see her … for me it feels more real … it feels more legitimate … it’s eye to eye, face to face, you know. And we’re looking right at each other and talking. And she’s dedicated to me. She’s paying attention to me and I’m paying attention to her … And that’s where the comfort level comes in. It’s just much more comforting that way than somebody on a phone, you know.	The ability for the Veterans across the country, especially in more rural areas or in areas without access to a bigger center, have the opportunity to see a cancer specialist who focuses on their area of disease. I think that’s probably the biggest advantage. Some of these VA centers also do not have oncologists. So, I think just a broader availability to get care closer to home. The communication, even though its virtual and remote, it’s really expedited. If I was in physical VA, there’s no way I’d be able to communicate with the pharmacist, the social worker, the scheduler, the nurse, the lab, in a matter of minutes.
	Veteran Quotes	Provider Quotes
Inner Setting/ Implementation Climate: Tension for Change	"I couldn’t make it without it … I don't see where anyone could go through a serious life-threatening disease or illness without some type of care. I think you would just die prematurely … So, it's absolutely essential” “Without the video, our unit at [HUB SITE NAME REDACTED] would be in big trouble because of the turnover of oncology doctors[…]So the video conference gives you hope … when you hear that, ‘well, your doctor isn’t here anymore’ is rather depressing at times. You think, ‘well, now what? Are we going to get a doctor or not?'” “Well … it's vital … There's no alternative at this point.”	"I do feel that a lot of veterans want to stay locally and don’t want to go a different community center, they feel comfortable in the VA system, so for those patients I do think it’s important and at many of these sites the closest even community care center is quite far, so I think it is advantageous to those patients.” “I think it's [the NTO program] done a really good job so far. There's always kinks that could be worked out in a new program and things that could be worked a different way. But if these patients had been trying to get all of their oncology care through care in the community, and go through multiple different providers, and possibly multiple different facilities, and they have various people in their care in the community department that are going to be gathering these records and bringing them forward; whereas with NTO we have one team that's looking over every aspect of care for this one patient, so there's less of chance that these things are going to be lost in translation somewhere.”
	Veteran Quotes	Provider Quotes
Outer Setting: Patient Needs and Resources	"I'm just really grateful. They've been really good at it. It's convenient to do it over the phone. I don't have to drive two hours to [HUB SITE REDACTED] to see somebody that's just going to tell me the same thing I can get over the phone. And the treatment I've been able to do it on a outpatient basis in my hometown, you know, close by where I live … And with her [the oncologist] on the phone just made it convenient way to do it instead of being a real hassle like it could have been.” “The very nice thing about it was we [he and his wife] had every opportunity and were encouraged to take that opportunity to speak our mind, to ask questions, to evaluate treatment outcomes and projections and everything such as that. I mean, it was very professional, and in fact, I felt absolutely comfortable in that environment of talking to a screen with a picture on it with moving lips.” “Because of the seriousness of my illness, I would have rather it been face-to-face with the doctor. And it was a new experience, you know, something new in my life, and … it was devastating. I guess the human TLC part of it, you know, the doctor, being able to sit there with the doctor for comfort and assurance was different, but I found that comfort and assurance um through the staff that were there and my family that was with me.” “I think … you lose just a little of the personal touch between the doctor and the patient by doing the video conference … I kind of like to have a doctor there, but uh it’s been okay, and I don't think it’s been anything that would affect anything.”	"Traditionally it's been more general oncologists taking care of patients and I know in my personal experience working with the National TeleOncology program and taking over the care of patients who previously had been cared for by a general oncologist, is that they didn’t have as nuanced care as I think that they are getting through having specialists with a special focus in their type of cancer or blood disorder. So, I think that that is a reason for why it's [the NTO program] an essential part of the care that veterans can receive and even in places that are staffed at a high level, but they may not be staffed with a certain specialist in that disease area.” “We've had patients tell us that they realize there is a team behind it. It's not just the doctor and the nurse that's in the call, they realize they've got the pharmacist, the practice providers, that they have a whole group of people that are working for them. More than once we've had patients really compliment us on that process.”
	Veteran Quotes	Provider Quotes
Process: Reflecting and Evaluating	"[…] I think that they do need to send them, you know, to a person who can show them how to pull it [video calls from home] up … whether it be on their phone, if they have a tablet or whatever, and iPad … and so they can help them get it set up I think would be very beneficial and … .I think the Veterans would feel a lot more comfortable knowing they had proper training on how to use teleoncology.” “I would say communication. Keep trying to improve that … a lot of times there are questions that you have and you should feel free to ask of them. And they've been pretty good about that. But see, I'm not a doctor or anything, and sometimes I have questions … they [doctors] don't always understand the question or something. Just get it cleared up and answer it in a way so they [patients] understand … and … provide an opportunity that you could either call back or answer it or get it cleared up would be helpful.” “Some of the Veterans that I know they do need that assistance [with TO] and some of them are not necessarily computer savvy … But that would be the only drawback I see … I mean, there's many, many volunteers that are willing to go to their house and hook them up or bring a laptop, or, I mean, those are just physical things. And I'm sure they could be all handled down the road."	They created a great foundation, I believe, and I think that's crucial to the success of the program. They brought in 99% excellent providers and care coordinators. “Another thing that would be useful is an assessment for physicians how much time they are working … because I fear that on face value it might look like a physician has a lot of free time, and so more work is going to be put on them.”

Note: These 12 selected Veteran quotes represent exemplars from 10 different Veteran participants, two of whom had two quotations. These eight selected provider quotes represent exemplars from six different provider participants, two of whom had two quotations.