Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Stakeholder perspectives on the impact of COVID-19 on oncology services: A qualitative study (#158)

Joanne Shaw 1 , Phyllis Butow 1 , Polly E Havard 1 , Zoe Butt 1 , Brian Kelly 2 , Louise Sharpe 1 , Haryana Dhillon 1 , Raymond J Chan 3 , Megan Best 4 , Lisa Beatty 5 , Maria Cigolini 6 , Philip Beale 7 , Laura Kirsten 8 , Ilona Juraskova 1
  1. Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
  2. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  3. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
  4. Institute for Ethics and Society, University of Notre Dame, Sydney, State/Territory, Australia
  5. Orama Institute, College of Education, Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
  6. Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
  7. Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
  8. Nepean Cancer Care Centre,, Nepean Hospital, Sydney, NSW, Australia

Aim: In response to COVID-19, cancer services in Australia adapted quickly to reduce infection risks for staff and patients, while maintaining an appropriate level of cancer care. This study, conducted by the Psycho-oncology Co-operative Research Group (PoCoG), aimed to document changes to oncology care in Australia, and the impact of these changes and COVID-19 more generally, on Australians living with cancer, family carers, and Oncology health professionals.

Methods: A longitudinal mixed methods study involving three short surveys and semi-structured telephone interviews over 12 months was conducted. Stakeholders were asked to reflect on their experiences and perceptions of the impact of COVID-19. Demographic and clinical characteristics were elicited and psychological wellbeing assessed. Interviews were thematically analysed using a framework approach.

Results: Seventy eight stakeholders (32 patients, 16 caregivers and 30 HPs) completed baseline interviews, 52 completed (23 patients, 10 caregivers, 19 HPs) 6 month interviews and to date 25 (9 patients, 4 caregivers, 11 HPs) 12 month interviews have been completed. Across timepoints, thematic analysis identified three themes related to the emotional impact of COVID-19 as common to all groups: fear and death anxiety, uncertainty, and isolation. Four change themes were also common to all groups:  safety, increased stress and loss of support, communication challenges and gains, including information access and communication quality; and quality of care. Safety was a paramount concern. HPs worried patients and carers were prioritising COVID-19 safety over seeking appropriate cancer care. Telehealth impacted communication and caregivers felt excluded. Patients and caregivers felt reduced support was available. HPs found telehealth and COVID-19 communication took up more time and the information overload was exhausting. HPs were also anxious about potential moral distress should the health system become overwhelmed.

Conclusion: Changes made to cancer services in response to COVID-19 left many feeling excluded, or ill-informed, and for some, a sense that quality of care had been impacted. While health service changes were deemed necessary and effective in controlling the risk of infection, it is vital that moving forward, changes are carefully reviewed and reversed unless deemed valuable.