Racial disparities in patient provider communication in telehealth versus face-to-face visits: a focus on Asian and Native Hawaiian and Other Pacific Islander cancer patients (Preprint)

BACKGROUND Telehealth services are becoming increasingly more common in the care of oncology patients since the advent of the COVID-19 pandemic. However, it is not known if patient-physician communication via telehealth is equally effective among all racial groups. OBJECTIVE The objective of this study was to compare patient satisfaction with communication during telehealth versus face-to-face visits among oncology patients with a specific focus on Asian and Native Hawaiian and Other Pacific Islander (NHOPI) patients. METHODS We performed a cross-sectional study of a racially diverse group of cancer patients who had experienced a face-to-face or telehealth visit. Questions assessing satisfaction with patient-physician communication were adapted from a previously published study of a racially diverse population of cancer patients. Variables impacting communication included age, sex, household income, education level, and cancer type and stage were captured. Multivariable logistic models for patient satisfaction were created with adjustments for sociodemographic factors. RESULTS There were a total of 593 participants, 362 in the face-to-face group and 231 in the telehealth group. Racial distribution of the population was 24% White, 58% Asian, 13% NHOPI, and 5% other. Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those who underwent a telehealth encounter. Lower levels of satisfaction during telehealth visits were demonstrated among Asian and NHOPI participants compared to Whites even after adjusting for sociodemographic factors. For example, degree of agreement with the statement, “Your physician listened carefully to you” was significantly lower among both Asians (OR 0.27, 95% CI 0.12 to 0.62) and NHOPI (OR 0.20, 95% CI 0.08 to 0.57) patients. Importantly, there were no significant racial differences in communication during face-to-face visits. CONCLUSIONS Asian and NHOPI patients were significantly less content with patient-physician communication during telehealth visits than White patients. This difference between racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparity in healthcare satisfaction should prompt further exploration.