Abstract
Background: Telemedicine, use of telecommunication and information technology to provide remote healthcare, is an alternative to face-to-face consultations to support sustainability, increase quality and improve patient experience at lower cost. Using telephone in routine follow-up potentially improves healthcare access, convenience, and choice. However, research identifies health disparity and inequality for some. We focus on haemato-oncology due to the patients’ clinical and psychosocial vulnerability, complex disease behaviour, treatment, and care needs.
Objective: To undertake a realist review of the relevant literature to develop theories of what works, for whom, why and under what circumstances when telephone consultations are used for routine follow-up in haemato-oncology and haematopoietic stem cell transplant (HSCT).
Methods: Electronic database, grey literature and forward citation searches (using Google scholar) identified studies assessing outcomes related to telephone consultations in haemato-oncology and HSCT patients. Included studies were assessed for relevance and rigour. Relationships between contexts (C), mechanisms (M), and outcomes (O) were extracted from sources. CMO configurations were developed and refined iteratively. A stakeholder group of cancer patients contributed to their refinement.
Results: Eleven included studies were synthesised. Final programme theory was developed from 19 CMOCs and included five inter-related themes: healthcare professional (HCP) relationship, confidence in telephone telemedicine, receiving care closer to home, COVID-19 and service resources. Findings highlight the importance of considering context at different levels: individual, interpersonal, institutional, and infrastructural. Final theory shows that key contextual factors (e.g., patient-HCP relationship) influence the workings of key mechanisms (e.g, trust and adherence) in producing outcomes and explain why, how and for whom telephone consultation works in this context.
Conclusions: This is the first realist synthesis in this area. The final programme theory suggests that individual patient-related contextual factors and the HCP-patient relationship should be considered by health professionals offering telephone consultations since these factors likely influence health inequality and patient safety.