Cancer, cognition, and COVID: delivering direct-to-home teleneuropsychology services to neuro-oncology patients

Melissa M Gardner; Farah J Aslanzadeh; Giuliana V Zarrella; Sarah E Braun; Ashlee R Loughan; Michael W Parsons

doi:10.1093/nop/npab021

Cancer, cognition, and COVID: delivering direct-to-home teleneuropsychology services to neuro-oncology patients

Neurooncol Pract. 2021 Apr 8;8(4):485-496. doi: 10.1093/nop/npab021. eCollection 2021 Aug.

Authors

Melissa M Gardner^{1

2}, Farah J Aslanzadeh³, Giuliana V Zarrella¹, Sarah E Braun^{4

5}, Ashlee R Loughan^{4

5}, Michael W Parsons^{1

6}

Affiliations

¹ Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
² William James College, Newton, Massachusetts, USA.
³ Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.
⁴ School of Medicine, Department of Neurology, Division of Neuro-Oncology, Virginia Commonwealth University, Richmond, Virginia, USA.
⁵ Massey Cancer Center, Richmond, Virginia, USA.
⁶ Stephen and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Background: The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients' home (DTH) had minimal prior study.

Methods: We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020.

Results: A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience, and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP.

Conclusions: These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (eg, reliability, validity) for neuro-oncology patients is warranted.

Keywords: COVID-19; DTH-TNP; neuro-oncology; neuropsychological assessment; teleneuropsychology.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.