Feasibility and sociopsychological impact of video consultations in medical oncology - a randomized controlled open label trial

Background: Mobile phone video call applications generally did not undergo testing in randomized controlled clinical trials prior to their implementation in patient care regarding the rate of successful patient visits and impact on the physician-patient relationship. Methods: The NCT MOBILE trial was a monocentric open-label randomized controlled clinical trial of patients with solid tumors undergoing systemic cancer therapy with need of a follow-up visit with their consulting physician at outpatient clinics. 66 patients were 1:1 randomized to receive either a standard in-person follow-up visit at outpatient clinics or a video call via a mobile phone application. The primary outcome was feasibility defined as the number of successful appointments at the first follow up visit. Secondary outcomes included success rate of further video calls, time spent by patient and physician, patient satisfaction, and quality of physician-patient relationship. Findings: Success rate of the first follow up visit in the intention-to-treat cohort was 87.8% for in-person visits and 78.7% for video calls (p=0.51, RR=0.88-1.43 95%CI). The most common reasons for failure were software incompatibility (12%) in the video call and no-show (6%) in the in-person visit arm. The success rate for further video visits was 91.6% (11 of 12 calls). Standardized patient questionnaires showed significantly decreased total time spent and less direct costs for patients (95 to 246min 95%CI, & 4.8 to 23.9 Euro 95%CI) and comparable time spent for physicians in the video call arm (-6.4 to 5.4min 95%CI). Doctor-patient relationship quality mean scores assessed by the validated standardized 'questionnaire on quality of physician-patient interaction' (QQPPI) were higher in the video call arm (video call/in-person = 1.12 fold, p=0.02). Interpretation: Follow-up visits with the tested mobile phone video call application were feasible but software compatibility should be critically evaluated. Trial registration: Retrospectively registered in the German Clinical Trials Register DRKS00015788, 26th October 2018