What’s Driving the Digital Divide: Patient Perspectives on Oncology Telemedicine

According to a qualitative study published in JCO Oncology Practice, barriers to telemedicine adoption in oncology may extend beyond broadband infrastructure, highlighting the role of structural constraints, patient experience with technology, and enduring preferences for in-person care.¹

Investigators conducted interviews with 24 patients residing in regions with limited access to high-speed internet, or low-broadband regions, receiving care at Mayo Clinic in the Upper Midwest region of the United States. The study included a group of patients who transitioned to telemedicine after the COVID-19 pandemic and another group of patients receiving exclusively in-person visits. These interviews identified motivations, driving factors, and attitudes toward visit modalities that ultimately shaped differential telemedicine adoption among the 2 groups.

Views on Visit Modalities

Across both telemedicine users and nonusers, patients identified clear clinical scenarios in which they believed in-person care was necessary, including physical examinations and complex interventions such as chemotherapy, stem cell transplantation, and surgery. Both groups preferred in-person care for its perceived thoroughness while acknowledging value in telehealth video visits for minor issues or routine follow-ups; however, many patients in both groups reported that video visits were not routinely offered by their oncology teams, limiting opportunities for adoption. This lack of proactive offering was particularly evident among nonusers, who largely continued with exclusively in-person care.

Differences also emerged in how each group engaged with telemedicine. Telemedicine users described adopting telehealth visits later in the pandemic, often driven by external factors such as hazardous travel conditions. In contrast, nonusers discussed telemedicine more hypothetically, framing it as a potential option under specific circumstances such as severe weather or future mobility limitations, rather than as a current component of care.

The Role of Technology

Technology-related factors played a secondary but still meaningful role in shaping telemedicine use. Across both groups, digital literacy varied and was influenced by age, professional background, and availability of support from family members. However, limited broadband access alone was not identified as the primary barrier to adoption. Instead, patients more frequently cited lack of familiarity and confidence with telehealth platforms.

Patients described difficulty navigating enterprise-specific telemedicine systems, as well as uncertainty in managing video-based interactions. Some reported that the technology felt nonintuitive, which affected their ability to engage fully during visits. Concerns extended beyond usability to include the perceived clinical limitations of virtual care, with some patients expressing worry that telehealth visits could miss subtle but important clinical findings.

The interviews also identified group differences in technological experience. Telemedicine users reported a progression in their use of telemedicine, with increasing familiarity and evolving perceptions over time. By contrast, nonusers had limited direct exposure to telehealth visits and often based their perceptions on secondhand experiences, such as those of family members. This indirect familiarity corresponded with narrower comfort and lower readiness to adopt telemedicine.

Patient Preferences and Motivations Drive Engagement

Motivational factors further influenced engagement with telemedicine. Patients in both groups consistently expressed a preference for in-person visits, citing greater comfort, stronger interpersonal connection, and a sense of thoroughness. The ability to see clinicians physically and establish rapport was described as central to oncology care. Concerns about video quality, communication gaps, and potential misunderstandings reduced willingness to rely on telemedicine.

Despite these reservations, patients acknowledged situational benefits of telemedicine. Both groups recognized that telehealth visits could reduce travel burden and improve access during challenging circumstances; however, these benefits were weighed against perceived trade-offs in care quality.

Motivational differences between groups reflected varying degrees of experiential engagement. Telemedicine users described telemedicine in both practical and emotional terms, balancing convenience with a perceived loss of “realness” compared with in-person visits. Their accounts suggested a nuanced acceptance shaped by lived experience. On the other hand, nonusers emphasized logistical considerations such as scheduling and avoiding unnecessary travel but remained largely uninterested in adopting telemedicine unless required by circumstance.

A Hybrid Model of Care to Improve Adoption

Overall, the findings indicate that telemedicine adoption in oncology may be constrained less by traditional factors like internet access, and more by a combination of clinical appropriateness, patient experience, and entrenched preferences for in-person care. Even in settings where telemedicine may offer logistical advantages, its role may be limited by perceptions of reduced clinical adequacy and interpersonal connection viewed as essential to oncology care.

To improve telemedicine uptake in oncology, the authors emphasized the need for approaches beyond expanding digital access alone. Based on the unique preferences and experiences of both groups, they proposed a hybrid model of care that integrates both in-person and video appointment visits with tailored supports based on clinical context. As noted by authors Pravesh Sharma, MD, and colleagues, “Expanding video care in oncology requires more than digital access and depends on patient experience, care context, and human connection inherent in oncology care.”

REFERENCES

1. Sharma P, Kamath CC, Jeno SE, et al. Barriers, facilitators, and attitudes toward telemedicine adoption in oncology: A qualitative study of patients from low-broadband areas. JCO Oncology Practice. Published online March 20, 2026. doi:10.1200/op-25-01155