Advancing cancer care and equity through telehealth, communication science, and behavioral economics

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PROJECT SUMMARY/ABSTRACT (OVERALL) The University of Pennsylvania Telehealth Research Center in Cancer Care (Penn TRC) will apply insights from communication science and behavioral economics to design and test innovative telehealth strategies to improve effectiveness and equity across the cancer care continuum, with an emphasis on understanding mechanisms of action. The COVID-19 pandemic led to dramatic growth in the use of telehealth for cancer care delivery, fostered by both clinical need and temporary waivers. Telehealth strategies have included both synchronous communication (real-time video or telephone conferencing) and asynchronous communication (sequential health information exchange through text messaging or secure portals). Yet, fundamental knowledge gaps include the extent to which telehealth may be superior to non-telehealth care delivery strategies for access, quality, and outcomes; how telehealth may enhance or detract from achieving health equity in cancer care in the context of the digital divide and persistent cancer disparities; and the impact of telehealth on health care efficiency. The Penn TRC will address an overarching research theme: to apply insights from communication science and behavioral economics to design and test synchronous telehealth strategies, supported by asynchronous elements, to improve access, quality, outcomes, equity, and efficiency across the cancer care continuum. We focus on lung cancer as a model for telehealth across the care continuum, from screening to treatment to survivorship. We bring together a team of international experts in communication science, behavioral economics, cancer care delivery, telehealth, health care innovation, mixed methods, and health equity to achieve the following specific aims: 1) Apply concepts, strategies, tools, and methods from communication science and behavioral economics to design and test synchronous telehealth strategies, supported by asynchronous elements, to improve access, quality, outcomes, equity, and efficiency for patients across the care continuum; 2) Conduct a pragmatic randomized clinical trial to compare the effectiveness of telehealth strategies to increase shared decision making for lung cancer screening using a Sequential Multiple Assignment Randomized Trial (SMART) design; 3) Conduct two rapid-cycle pilot projects, with methods and measures aligned with the pragmatic trial, to design and test the effectiveness of telehealth to improve cancer care, identify multilevel mechanisms of action, and lay the foundation for future, more definitive pragmatic trials; and 4) Build capacity to advance a national telehealth research agenda and train the next generation of investigators with expertise in cancer care, telehealth and health equity. By joining together interdisciplinary faculty across Penn, the Penn TRC will result in novel, scalable, and generalizable disseminated strategies to drive lasting improvements in cancer care and health equity. Penn has an unparalleled environment in which to bring together these areas of study.