(P 311) VIRTUAL VISITS FOR SARCOMAS AND OTHER RARE CANCERS INCLUDING DESMOIDS: THE EVOLUTION OF INFORMATION AND EDUCATIONAL OPPORTUNITIES TO IMPOVE HEALTH: 2017-2022

Objective: : Information and education virtual visits using i-phone (FaceTime), Zoom, or other video software has been available at Cleveland Clinic since 2017. Our pre-pandemic experience was shared at 2019. Since the pandemic our virtual visit approach has evolved into process to provide 0.5-1 hour scheduled review of opportunities to improve health in an unrushed manner using Zoom. With the goal to provide information and education, virtual visits can review scans, plans, clinical trial options, and toxicity reduction to improve understanding or principles of sarcoma therapy and follow-up. This poster will share some of our insights that have helped sarcoma virtual visits to become routine and satisfying for patients, caregivers, schedulers, and treatment teams.

Methods: :Intake information is placed in a shared folder to facilitate making a draft summary. This MS Word.doc contains contact information, oncology past medical history as chronological outline (not a “narrative”), and a list of 6 cancer-related topics to provide information and education about principles of therapy and “opportunities to improve health” (table 1):
1. Local Control
2. Medical therapies (e.g. chemotherapy, immunotherapy. clinical trial options)
3. Scans and biomarkers
4. Anticipation and amelioration of side effects
5. Social considerations including building “therapeutic alliances”
6. Follow-up and so what is next

The summary is edited contemporaneously by the first author during the Zoom virtual visit. After-visit tasks include an EPIC distance health note, email with attachments, and if requested path review (table 2).

Results: Education and information virtual visits can facilitate better understanding of sarcoma biology, local control, medical therapy, clinical trials, imaging, toxicity, and building therapeutic alliances during complex multidisciplinary sarcoma care. These have become routine at Cleveland Clinic Children’s Hospital with high patient acceptance and almost zero “no-shows”. The first author does ~6 virtual visits for information and education every Tues/Thurs AM each week; other sarcoma specialists (Orthopedic Oncology, Radiation Oncology, and Pediatric Oncology) also provide virtual visits. Provider satisfaction and patient access seems superior for information and education virtual visits (>300/year) than formal written on-line sarcoma consultations (>50/year).

Platforms utilized have included FaceTime, AmWell, written second opinion on-line consults, and Zoom. At the present time Zoom appears to be the best platform because of ease in screen sharing (images on PowerPoint, EMR, article pdf), patient familiarity, and ability to send a link to others who want to join the virtual visit in real time (all you need is an email address). Barriers to participation were initially insurance or self-pay status; these are currently less of an issue.

Education and information virtual visits include discussion of principles of therapy, molecular testing, treatment options including “back-up plans” if therapy is ineffective, imaging, side effects, nutrition, and social issues (table 1). The draft summary is edited concurrently during the visit and emailed back to the patient and caregivers (e.g. spouse or parents; table 2). A distance health note is efficiently put into the Electronic Medical Record (EPIC) using the summary and snipping tool to place images, articles, and calendars so other providers of multidisciplinary care can benefit from knowing what was discussed and what information including images were shared via Zoom, too.

Conclusion: Virtual visits can provide information and education in a family-centered format. These can be particularly useful for low and high-grade sarcomas. Such visits have been rewarding for patients and caregivers alike and are also an excellent means to ameliorate toxicity, achieve” forward observation” facilitate therapeutic alliances, as well as to pre-screen for potential clinical trial options.

Table 1. Virtual Visit Summary of Opportunities to Improve Health.docx

Table 2. Tasks to Finish Strong after Sarcoma Virtual Visits.docx

Anderson - Virtual visit CTOS fig 1 prepB4vv.pptx

VV fig 2 Whose on First (the Patient).pptx