e13708 Background: Rural populations face systemic barriers to healthcare, including specialty scarcity, travel burden, and limited local infrastructure. While telehealth has emerged as a potential tool to bridge geographic divides, its equitable adoption remains unclear. This study seeks to evaluate telehealth use and quality, with a focus on rural cancer survivors. Methods: Nationally representative Health Information National Trends Survey data from 2022 and 2024 were analyzed; 2013 RUCA (1-3: urban, 4-9: rural) defined rurality. Any telehealth in the past 12 months was considered “use”. Patient-reported quality measures were dichotomized; telehealth was “as good as a regular in-person visit” (agree, disagree), internet connection satisfaction (satisfied, not satisfied), and health communication (always occurred vs any other response). Analysis in STATA used sampling and jackknife weights (50 replicates) to produce national representation. Design-based F test assessed for associations; survey weighted logistic regression was used when estimates were not calculable due to structural zero. Statistical significance was p < 0. 05. Results: 13, 530 were included (urban 87. 4%, 12. 6% rural). Rural participants were older (mean: 52. 5 yrs rural, 48. 4 urban), had lower income (< 50k: 48. 7% rural vs 36. 2% urban) and were more commonly cancer survivors (12. 0% rural, 8. 9% urban) (p < 0. 05 for comparisons). Most were insured (88. 6% urban, 89. 5% rural). Telehealth use declined from 33. 5% in 2022 to 29. 7% in 2024 (p < 0. 01), with rural participants overall less likely to use (31. 5% vs 36. 4% urban, p < 0. 01). Rural participants were less likely to be satisfied with their internet connection (56. 8% vs 70. 1% urban, p < 0. 01). Reasons for telehealth use differed, with rural participants more frequently using it for chronic diseases (24. 6% vs 17. 5% urban) and less for acute/minor illness (20. 3% vs 27. 7% urban) (p < 0. 05 both). Most agreed telehealth was as good as in-person care (77. 6% rural, 77. 4% urban), that providers explained things clearly (56. 8% rural, 57. 2% urban) and that they had a chance to ask questions (58. 3% rural vs 56. 8% urban). Telehealth was not associated with providers spending enough time (38. 6% telehealth vs 41. 2% no telehealth; 42. 5% rural vs 38. 1% urban) (p = NS for all comparisons). Cancer survivors had higher telehealth use (42. 5% vs 35. 1% without cancer, p < 0. 01), driven by urban survivors (43. 5% vs 35. 8% without cancer, p < 0. 01). Rural survivors did not have statistically different use (37. 0% vs 30. 7% without cancer, p = 0. 12). Conclusions: Telehealth has declined slightly over time, with ongoing barriers seen in rural populations, especially with internet connectivity. Given no differences in perceived quality and communication, differential telehealth use appears driven by structural factors rather than patient-provider relationships. Expanding reliable telemedicine access to rural cancer survivors may improve survivorship care.
Neilson et al. (Thu,) studied this question.