Teleneuropsychology:   Are Patient And Family Satisfaction And Understanding Of Cognitive Test Results Similar Across In-Person And Videoconferencing Modalities? Dr. JoAnne Savoie, L.Psych. Clinical Neuropsychologist Stan Cassidy Center for Rehabilitation

Goal Are patient experiences the same across in-person (IP) or videoconferencing (VC) feedback? How, if at all, do cognitive and emotional factors impact satisfaction and understanding of complex information?

Issue Clear communication of neuropsychological assessment Improves understanding of one’s thinking skills Contributes to one’s psychological well-being Improves rehabilitation outcomes Many factors influence optimal giving and receiving of assessment findings. cognitive deficits increase potential for misunderstanding and not remembering the results. TeleHealth adds another layer of complexity. There has been little empirical study of feedback as part of the neuropsychological assessment process and even less as it relates to providing the results in different modalities. Giving and receiving of findings: Clinician factors: style of sharing and degree of collaboration in feedback process Environment: distractions Patient factors: levels of insight, interest and motivation to learn about themselves At SCCR, options given to patient to receive feedback by VC to avoid costs and time constraints. My subjective experience was that it felt different when I did it this way. Harder to read their nonverbal cues, know when I’ve lost them, eyes start to glaze over, etc.

Measurement Sample questions 1. I was satisfied with the physical environment. 2. I was told what to expect. 4. I understood the results. 6. I learned useful info about my strengths. 7. I learned useful info about my problem areas. 9. I felt that the results received were accurate. 12. Feedback made me more motivated to follow recommendations. 13. I am satisfied with the results I received. 17. I appreciated receiving the results in person/ videoconference. Informed consent procedures followed at outset of the assessment. 55 patients (45 IP: 10 VC) and 35 accompanying loved ones. completed an 18-item questionnaire immediately following the feedback session. Patient data included: Demographic information Diagnosis Intellectual functioning (Wechsler Intelligence Scales) Emotional distress (BDI-II and BAI)

Intervention/Actions At the time of assessment, patient is given option for IP or VC feedback. Feedback usually 3-4 weeks after assessment. Encouraged to bring a loved one.

Correlations with total satisfaction scores Outcomes Sample Descriptives IP VC Age 41.8 34.7 Education 13.2 11.9 Verbal comprehension 94.4 94.0 Perceptual reasoning 98.7 104.0 General IQ 92.6 96.0 Depression 18.8 21.6 Anxiety 14.7 17.0 Patient satisfaction levels high across both modalities. Patients and loved ones report similar experiences (r=0.63, p<.001). Emotional distress levels did not predict overall satisfaction. Intellectual skills did not correlate with overall satisfaction. Correlations with total satisfaction scores Variable Correlation (r) p-value Depression .14 .36 Anxiety -.07 .68 Verbal comprehension -.02 .89 General IQ -.08 .56

Lessons Learned Reassurance that feedback is well received in both modalities. Overall - good understanding of results and satisfaction with its delivery. Satisfaction and subjective understanding of results is not impacted by intellectual functioning or emotional distress levels. Limitations Self-selected groups Small sample in VC sample Based on self-report. Impact of insight? Agreeableness? New questions Is amount of information stored the same? What cognitive factors might impact retention and recall of information? Are therapeutic recommendations followed similarly across modalities?