27th November 2020

Virtual consultations are not appropriate when giving bad news

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A new report has found people with lung cancer are more likely to worry about receiving bad news if offered a video or telephone consultation.

Since the coronavirus pandemic, virtual appointments are becoming more commonplace, with 92 per cent of patients having at least one conversation with their nurse or hospital physician virtually.

However, the report, which is supported by Roy Castle Lung Cancer Foundation, British Thoracic Oncology Group, Lung Cancer Nursing UK and UK Lung Cancer Coalition, has revealed around half of lung cancer patients would be ‘worried’ or ‘extremely worried’ if offered a video or telephone appointment (50 and 41 per cent respectively) during the pandemic.

95 per cent of patients agreed that meeting their consultant or nurse face-to-face was, by far, the best method of communicating their diagnosis.

Lorraine Dallas is the Director of Patient Information and Support at Roy Castle Lung Cancer Foundation:

“Every patient worries about getting bad news and for healthcare professionals breaking bad news is one of the hardest aspects of their job.

Virtual consultations are simply not appropriate in this situation, particularly as many lung cancer patients are diagnosed at the late stage of their disease.

Being told you have lung cancer, or your disease has become incurable is life-changing news and a phone or video consultation is not the right way to find out.”

Nearly seven out of ten (69 per cent) of people were not given a choice between telephone or video. The majority of virtual appointments have been by telephone (90 per cent) with only 13% of lung cancer patients receiving video consultations. Of those who have had a video consultation, 71 per cent found them more convenient than visiting hospital.

However, more than three quarters (76 per cent) of healthcare professionals surveyed said they had not received any training or guidance for delivering virtual appointments and almost two-thirds (65 per cent) said lack of computer equipment to hold video consultations was a regular problem. Other disadvantages included the inability to share visual material such as scans with their patients; difficulties in assessing a patient’s physical condition virtually; and the lack of quiet, private, meeting spaces in a hospital to be able to deliver video consultations.

Professor Sanjay Popat is a Consultant Thoracic Medical Oncologist at the Royal Marsden NHS Foundation Trust and the Steering Committee Chair of the British Thoracic Oncology Group.

“The fact that video is so seldom used to deliver virtual consultations may surprise some people – but not those working within NHS hospitals.

This survey exposes some of the huge infrastructure changes that need to happen to make video consultations workable long-term in both secondary and tertiary lung cancer care settings.”

The report has now highlighted a series of key considerations to help improve the use of virtual consultations, and develop best practice tools – not only for lung cancer, but other cancer services and the wider NHS:

  • – Further research is needed into the use of virtual consultations involving patients who do not have computer access, or feel confident in using them, to ensure health inequalities are not being exacerbated
  • – Healthcare professionals should be provided with training to support both communication and technical aspects involved in the delivery of virtual consultations
  • – Given the often, late stage, diagnosis and urgency that comes with it, there is a need for lung cancer-specific best practice guidelines which go beyond current general clinical guidance for the management of remote consultations.2,3
  • – Resource will be needed if NHS Trusts are to invest in the technology needed to make virtual consultations an integral part of the patient pathway.

Click here to read the full report.