The increase in telehealth entails great opportunities to increase patients’ access to cancer professionals and to streamline the workflow of health care providers during and beyond the COVID-19 period. Furthermore, telehealth holds tremendous potential for the transforming the follow-up care, with a reduced burden for in-person visits. However, important concerns relating to associated regulatory frameworks, digital poverty and exclusion, and the respect of patients’ preferences need to be addressed concomitantly to its deployment. Here, we present a clear multilevel strategy and development of best practices required to address these barriers (Table 1). First, at the patient level, we recommend a comprehensive assessment for patient-level barriers, including readiness to use telehealth, access to broadband, disabilities that limit telehealth use, and limited digital literacy. Telehealth access can be improved through interventions such as patient-level training, voice-activated commands, simpler designs, engaging informal caregivers, and finally improving interpreters’ access to the telehealth portal. Second, at the health system level, it is crucial to design clinical workflows with a health equity lens to not exacerbate existing disparities but to increase access to care. To be genuinely successful, patient education and training for digital and telehealth tools must be built within clinical workflows to address disparities in access. While this training is often time-consuming and resource-intensive, it is an investment in excellent cancer care that is likely to increase patient engagement. One potential option is to leverage lay health workers and navigators for this type of training. Third, telehealth systems were primarily designed for business community and have not been optimized for team-based care including interpreters, volunteers, and administrative personnel. These systems should address these barriers, informed by patient experience, and incorporate feedback from end-users, including both clinicians and patients on an ongoing basis. Finally, telehealth can be improved at the policy level by continuing reimbursement for telehealth; setting requirements for telehealth systems including ease of access, privacy, reimbursement for time, and resources for patient training; and increasing support for access to broadband and telehealth devices for low-income individuals. To gain additional benefits from digital technologies, greater personalization, monitoring, and engagement of patients with digital solutions must be integrated into services.
Going forward, the supportive care community can build systematic and collaborative programs of pragmatic research to optimize equitable telehealth clinical models. Such research should continue to shape developments of telehealth in cancer, exploring and testing solutions to address barriers at all levels. Ongoing research programs should evaluate comprehensive cancer care outcomes, patient-reported measures, ease of use, patient engagement, patient preferences, and implementation outcomes with a specific focus on disparity indicators (e.g., reach, adoption, and sustainability). It is also essential that these research programs influence policy across the health care systems. As the peak multi-national association for excellence in cancer supportive care, MASCC will be best placed to develop evidence-based guidance for solutions and implementation strategies to overcome disparity and maximize equity in telehealth for people affected by cancer.