115: Virtual consultations: The experience of oncology and palliative care healthcare professionals ‘One size doesn’t fit all’

Introduction: To maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient practitioner interactions. Prior to this, little was understood regarding healthcare professionals’ (HCP) experiences in translating their care to this modality. Aim: Exploration of oncology and palliative care HCP perspectives on VC, the role of VC in varying stages of the treatment and management of patient care, and the future role of VC in patient care. Method: A cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. Results: 87 surveys completed within a one-month period. Three master themes were identified. Personal, professional, and familial factors included factors of patient age, illness and VC skill in influencing HCPs’ experience of VC. Relationships and connection highlighted the influence of VC in empowering patients, the importance of a therapeutic relationship. Here, there was a perceived loss in these domains with VC. Significant challenges were felt in sharing bad news and having challenging conversations. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant barrier, alongside the challenges faced with sometimes failing technology. Conclusion: VCs have a stronger role for those patients who are already known to professionals, when prior relationships have already been developed, and here they are perceived as practical and beneficial. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patients with regard to suitability prior to offering VCs, with emphasis on the importance of patient choice, were seen as priority areas in this new era of VCs

A mixed methods exploration of oncology and palliative care healthcare professionals experience of virtual consultations

Background/aims: Virtual consultations (VC) were widely used during the Covid-19 pandemic to ensure continuity of care. Prior to this, little was understood regarding healthcare professionals’ (HCP) experiences in translating their care to this modality. Exploration of oncology and palliative care HCP experience of VC, and the future role of VC in patient care. Methods: A cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. Results: 87 surveys completed within a one-month period identifying three master themes. Relationships and connection highlighted the influence of VC in empowering patients, the importance of a therapeutic relationship and its perceived loss within VC modalities. Majority of respondents reported considerable challenges having difficult conversations with patients using VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Personal, professional, and familial theme included factors of patient age, severity of illness and VC skill (patient and professional) in influencing HCPs’ experience. Within the domain of logistical and practical implications, increased accessibility was seen as a benefit of VC, as well as the environmental benefits of reduced travel and time. Participants raised concerns regarding overlooking clinical signs and an inability to examine patients, necessitating increased follow up requirements, alongside the anxiety faced with occasionally failing technology. Conclusions: VC benefits were mainly noted when used for patients already known to the professional, during stable treatment reviews. VC for difficult discussions and for unstable patients were felt to be unsatisfactory and a barrier to their use. There was a strong preference for patient choice in choosing the preferred consultation modality, alongside prior triaging of the appropriateness of VC for individual patients

Virtual consultations: the experience of oncology and palliative care healthcare professionals

Objectives: To maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient-healthcare practitioner interactions. The aim of this study was to explore the views of oncology and palliative care healthcare professionals (HCPs) regarding the medium of VC. Method: A cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. This was undertaken in accordance with relevant guidelines and regulations. Results: 87 surveys were completed. Three master themes were identified. Personal, professional, and familial factors including patient age, illness and VC skillset all influenced practitioner’s experience of VC. Relationships and connection were highlighted by survey respondents as important influences, with a perception that VC could reduce usual relationships with patients, compared to previous face-to-face consults. There was a perceived loss in these domains with VC. Sharing bad news and having challenging conversations was seen as particularly difficult via VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a significant benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant worry, alongside the challenges faced with occasionally failing technology. Conclusion: VC were felt to have a role for those patients who are already known to professionals, where there was an established relationship. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patient suitability prior to offering VC, with emphasis on the importance of patient choice, was seen as a priority in this new era of VC

Mediators of negative content and voice‐related distress in a diverse sample of clinical and non‐clinical voice‐hearers

Objectives: Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice‐related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice‐related distress. This study aimed in examine mediators of the negative content voice‐related distress relationship in clinical (those who recently received input from mental health services) and non‐clinical voice‐hearers. Methods: One hundred and twenty‐one adults (71.9% female; 35.5% mixed or non‐white ethnic background) who hear voices were recruited online and completed self‐report measures of negative content of voices, voice‐related distress, mindfulness of voices, interpretation of loss of control, thought suppression and intrusion. Results: Clinical voice‐hearers had significantly higher levels of negative content, voice‐related distress and interpretation of loss of control than non‐clinical voice‐hearers. A mindful approach to voices and interpretation of loss of control mediated the relationship between negative content and voice‐related distress across the whole sample. Thought suppression and intrusion did not mediate the relationship. Conclusions: The results support the use of mindfulness‐based psychological intervention to reduce voice‐related distress. Further development of valid and reliable measures specifically relating to constructs of voice content, voice‐related distress and voice suppression will support further research in this area

Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. Funding: Department of Health and Social Care

Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated crosssectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards

Community prevalence of SARS-CoV-2 in England during April to November 2020: Results from the ONS Coronavirus Infection Survey

Background Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards