The COVID-19 pandemic has transformed how cancer care is delivered. In the Canadian province of Manitoba, most cancer care is delivered by a provincial, centralized agency, CancerCare Manitoba (CCMB). During the COVID-19 pandemic, CCMB implemented changes to mitigate the risk of contracting the virus for patients with cancer as well as health care providers. These changes have included routine screening for signs of infection prior to staff, patients, and informal caregivers entering facilities, limiting the number of informal caregivers that can accompany patients to appointments and procedures, and the routine use of personal protective equipment (PPE) by health care staff who provide in-person care to patients [1]. Perhaps the most remarkable change in clinical practice has been the dramatic increase in the use of telemedicine by physicians.

Telemedicine and telehealth are closely related but distinct concepts [2,3]. The American Academy of Family Practitioners (AAFP) provides clear definitions of these terms [3]. The AAFP defines telehealth as the use of telecommunication strategies to deliver health care and health care–related services such as the education of health care professionals. Telemedicine is more narrowly defined and refers specifically to the delivery of medical care using telecommunications, suggesting that it is a distinct entity within the umbrella of telehealth. It should be noted that the distinction between the two terms is not recognized by all, as the terms telemedicine and telehealth have been used interchangeably by some authors [4].

In Manitoba, a provincial telehealth service has been long-standing, which facilitates telemedicine services through physician-to-patient videoconferencing services. In the cancer setting, these services link specialists working in the urban cancer centers (ie, in the cities of Winnipeg and Brandon, Manitoba) with patients attending appointments in rural and remote centers throughout the province. In response to the COVID-19 pandemic, CCMB physicians rapidly adopted telemedicine solutions outside of the formal Telehealth service. Microsoft Teams, Zoom, and other consumer-level videoconferencing services, in addition to the increased use of telephone calls, have been used in lieu of clinic visits to keep patients, informal caregivers, and health care providers safe by limiting traffic in health centers and reducing the need for in-person clinic visits.

In cancer care, physicians are often required to share sensitive and complex information with patients and those supporting them. Information needs are among the most commonly cited unmet supportive care needs [5,6], and it is not clear how receiving information, including that which is considered to be “bad news,” through telemedicine impacts the patient experience. With the rapid increase of telemedicine services during the COVID-19 pandemic, including the use of informal telemedicine services in Manitoba, it is necessary to better understand how telemedicine affects the experience of receiving information from physicians.

Telemedicine and telehealth have been explored outside of the cancer setting, with numerous intervention trials and systematic reviews both completed and underway [7]. Additionally, guidelines exist to help guide best practice for the use of telemedicine [7], such as those developed by the American Association of Telemedicine [8]. However, in the unique setting of oncology, there appears to be a lack of empirical evidence to guide best practices. Prior to undertaking this review, the literature was searched to identify literature that would be helpful for guiding best practices. The search included several databases (JBI Evidence, Cochrane Systemic Reviews, and MEDLINE) and did identify numerous studies that have explored the experience of receiving cancer care through telemedicine, with two reviews identified that summarized the qualitative evidence regarding the experience of patients with cancer and informal caregivers accessing telemedicine [9,10]. However, no review could be identified that addressed specific activities or practices oncology physicians could employ to improve the experience of receiving care through telemedicine. Of note, a recent publication on delivering bad news using telemedicine in the oncology setting based on expert opinion guided by the SPIKES framework [11] was identified, but it is noted that this framework was not specifically designed in the context of telemedicine.

Systematic, scoping, and mapping reviews are 3 different types of systematic literature review methods, each with distinct procedures and outputs. Systematic reviews are useful when a decision regarding changes to current practice is required [12]. Scoping reviews, which may be a precursor to systematic reviews, help to identify the types of evidence available on a given topic, clarify concepts, examine how research has been conducted, and identify knowledge gaps [12,13]. Mapping reviews, on the other hand, do not answer specific questions about a topic, but identify what evidence exists regarding a certain topic [14,15]. As the literature relevant to the required objectives does not appear to have been previously summarized, a scoping review was selected as the best review strategy.

Based on how telemedicine has been adopted at CCMB during the COVID-19 pandemic, the relevant objectives for this review are the following: (1) to identify how telemedicine in the oncology setting has been studied in the literature, (2) to identify what specific clinician practices have either been demonstrated or suggested to be helpful in terms of improving the patient/friend/family experience, and (3) to identify future research directions to improve the integration of telemedicine with clinical oncology care.

This scoping review protocol is based on the methodology developed by the Joanna Briggs Institute (JBI) [12,16]. In keeping with their procedures, the following section will outline the specific review questions, study inclusion criteria, search strategy, and procedures for study selection, data extraction, and data presentation.

Study activities related to the scoping review will begin in December 2020. Results will be available by late spring 2021.

The protocol for this scoping review has been developed as a pragmatic response to the challenges faced by patients, their informal caregivers, and clinicians in accessing/providing clinical care during the global COVID-19 pandemic. The need to socially distance and take additional precautions to prevent transmission of the COVID-19 virus has likely had significant effects on the experience of receiving and delivering [20] cancer care. How these changes have impacted the delivery and receipt of information provided by clinicians to patients and their informal caregivers is not yet fully understood.

A recent report by the lead author of this protocol (MT) identified key characteristics of high-quality information. These emerged from semistructured interviews with 60 patients with cancer and their friends and family [21]. The interview data were analyzed using Classical Grounded Theory [22-24]. The key characteristics of high-quality information included accessibility, credibility, applicability, and framing. Accessibility was defined as the relative convenience and effort associated with receiving information about cancer. Credibility reflected how trustworthy/reliable the information was considered. Applicability referred to the degree with which the information received applied to the individual who received it. Framing was defined as how the information was presented, with particular focus on whether the information identified ways that the cancer situation could be optimized, either by clinicians or by the individuals receiving the information. Using the framework provided by this previous study [21], both from a patient and informal caregiver perspective, receiving care through telemedicine may be more accessible than through traditional in-person encounters. However, some important information conveyed through in-person interactions maybe not be transmitted. For instance, nonverbal information may not be delivered or received, making it challenging to both provide and receive care in sensitive contexts. This scoping review will be useful in identifying the different factors that have been found to affect the delivery of information using telemedicine in the cancer context as well as what areas have yet to be explored. The results will be useful to both clinicians and researchers in the context of the COVID-19 pandemic and beyond.