Patient perspectives on perioperative telemedicine in female malignancies: the role of age, digital experience, and privacy concerns

Abstract

Background

Telemedicine offers new opportunities in perioperative care, particularly for patients with female malignancies. This study investigated factors influencing patient acceptance of telemedical services during the preoperative phase.

Methods

Between May and November 2022, 145 patients with breast or gynecologic malignancies completed a structured questionnaire in a cross-sectional study during preoperative consultation. Sociodemographic factors, digital experience, and privacy concerns were assessed. Data were analyzed using descriptive statistics, t-tests, Chi-square, Mann–Whitney U-tests, and binary logistic regression.

Results

Overall, 69% of patients expressed agreement with perioperative telemedicine. Younger age (mean 50.6 vs. 59.3 years; p = 0.001) and greater digital experience, especially video call usage (p = 0.005), significantly predicted approval. The most preferred modality was browser-based video consultation (47%; p = 0.007). No significant associations were found for distance to clinic (p = 0.672), EQ-VAS score (p = 0.597), or number of prior clinic visits (p = 0.331). Barriers included data protection concerns (p < 0.001) and discomfort with receiving sensitive information via telemedicine (p < 0.001).

Conclusion

Most patients view telemedicine as a valuable supplement to traditional care. Acceptance depends on age, digital literacy, and the perceived sensitivity of clinical communication. Tailored implementation respecting patient preferences is essential.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-025-08067-7.

What does this study add to the clinical work

This study supports the patient-centered integration of perioperative telemedicine in gynecologic oncology by identifying age, digital experience, and privacy concerns as key determinants of patient acceptance.

Introduction

Telemedicine, defined as the remote delivery of healthcare services using digital platforms such as video calls, secure messaging, and electronic health records, enhances efficiency and accessibility, particularly for patients in rural areas or with limited mobility. A systematic review suggests that, when implemented in the appropriate context, telemedicine does not compromise the quality of care compared to conventional methods [1]. However, its effectiveness remains highly dependent on the specific clinical domain, warranting continued research across diverse specialties.

In gynecologic oncology, the complexity of perioperative care pathways calls for coordinated and patient-centered approaches. Enhanced Recovery After Surgery (ERAS) programs, known to improve both patient outcomes and healthcare resource utilization, may benefit from the integration of telemedicine [2–4]. The COVID-19 pandemic further highlighted the utility of telehealth in this setting, with patients expressing high willingness to engage in virtual consultations under appropriate conditions [5]. Prior studies confirm high satisfaction with telemedicine among gynecologic oncology patients [6]. Nonetheless, the development of user-centered eHealth programs for postoperative recovery remains an ongoing challenge [7].

Despite the potential advantages—such as logistical flexibility, improved access, and economic efficiency—barriers such as limited technological proficiency, infrastructural inadequacies, and a general preference for in-person interaction may impede broader adoption [8, 9].

The present study evaluated the acceptance of telemedicine among patients undergoing surgery for breast or gynecologic malignancies in a german women´s hospital. The primary objective was to identify demographic, clinical, and technological factors influencing telemedicine approval. The null hypothesis was that none of these variables would significantly affect patient acceptance.

Methods

Between May and November 2022, 145 female patients scheduled for oncologic surgery completed a structured questionnaire in a cross-sectional study as part of their preoperative consultation. The sample size reflects an inclusive, cross-sectional design aimed at capturing the perspectives of as many eligible patients as possible during the defined study period. As this was an exploratory, hypothesis-generating study without prior comparable data for power calculation, no formal sample size estimation was performed in advance. These individuals were selected from a larger pool of 735 patients treated during the same period, which also included 590 women undergoing procedures for benign conditions. Eligibility criteria included cognitive and linguistic capacity to complete the questionnaire independently. Participation was voluntary and anonymous, with implied consent through completion. Ethics approval was obtained from the University of Tübingen (Approval No. 544/2021BO2).

The 63-item questionnaire assessed demographic characteristics, treatment satisfaction, personal use of digital technology, and attitudes toward telemedicine. The instrument was specifically developed for this study, as no existing validated questionnaire adequately captured the combination of parameters required—namely, perioperative telemedicine acceptance, digital competence, and individual privacy concerns in the context of female malignancies. The questionnaire was based on a comprehensive literature review and expert input from clinical practice, ensuring content validity in the absence of standardized tools for this target population. Most questions were nominally or ordinally scaled. Data were collected and managed using REDCap electronic data capture tools (v9.8.5) hosted at the University of Tübingen, further processed using Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), and study figures were created using Microsoft PowerPoint (Microsoft Corporation, Redmond, WA, USA). Statistical analysis was performed using IBM SPSS Statistics Version 28.0.0.0 and included t-tests, Chi-square tests, and Mann–Whitney U-tests, depending on the variable type. Statistical significance was defined as p ≤ 0.05.

Results

Of the 145 patients surveyed, 57.6% had breast cancer, 23.8% cervical cancer, 10.6% ovarian cancer, and 7.9% endometrial cancer. Six patients had dual malignancies. In total, 69% of participants expressed either full or partial agreement with telemedicine in the perioperative setting. A further 23.4% disagreed, while 7.6% provided no response. Patients who approved of telemedicine were significantly younger (mean 50.6 ± 11.9 years) than those who disapproved (mean 59.3 ± 14.5 years; p = 0.001).

No statistically significant relationship was found between telemedicine approval and patients’ general health (EQ-VAS score; p = 0.597), the number of prior clinic visits (p = 0.331), or travel distance to the clinic (p = 0.672).

Marital status (p = 0.001), type of planned surgery (p = 0.008), and the expressed importance of in-person consultations (p = 0.025) were all significantly associated with telemedicine approval. In contrast, educational attainment (p = 0.373), employment status (p = 0.738), and parental status (p = 0.822) showed no statistically significant effect.

Regarding digital behavior, patients who had experience with video calling applications (e.g., Zoom, Skype, FaceTime) were more likely to approve of telemedicine (p = 0.005). Other digital habits, such as using email (p = 0.527), online banking (p = 0.701), or shopping online (p = 0.986), did not significantly influence telemedicine approval. Prior use of telemedical services and personal electronic health records was rare and not significantly associated with acceptance (p = 0.778 and p = 0.616, respectively).

The most preferred telemedical format was browser-based video consultations, significantly more favored than other formats (p = 0.007). Telephone consultations (p = 0.253), smartphone applications (p = 0.166), SMS (p = 0.986), and email-based communication (p = 0.172) were less frequently endorsed.

Reasons for telemedicine rejection included data protection concerns (p < 0.001), lack of familiarity with the necessary technology (p = 0.013), discomfort using digital devices (p < 0.001), and reluctance to receive emotionally sensitive information such as diagnostic results remotely (p < 0.001). A minority cited limited internet access (p = 0.004) or illness-related emotional burden (p = 0.749) as contributing factors.

Supporters of telemedicine were significantly more likely to believe that digital consultations could improve overall healthcare in Germany (p < 0.001), enhance their personal medical care (p < 0.001), support informed consent discussions (p < 0.001), and facilitate postoperative follow-up (p < 0.001). Nonetheless, even among proponents, the idea of communicating life-altering results via telemedicine was viewed critically (p < 0.001) (Fig. 1).

Fig. 1.

Overview of a cross-sectional study on perioperative telemedicine acceptance among female cancer patients

Discussion

This study highlights a broad acceptance of perioperative telemedicine among patients with female malignancies, consistent with previous findings showing high patient satisfaction with teleconsultations in gynecologic oncology settings [5, 6]. Younger age and prior digital experience were significant predictors of telemedicine approval, aligning with observations that digital literacy plays a crucial role in telemedicine engagement [10, 11, 27].

The preference for browser-based video consultations supports evidence that patients value telemedical interactions that replicate in-person communication as closely as possible [31]. Our findings further demonstrate that, despite technological advancements, concerns about data protection and digital device familiarity remain major barriers to telemedicine adoption [8, 9, 22, 23]. This highlights the persistent digital divide, particularly among older adults [27, 28].

Although theoretical acceptance was high, actual telemedicine use in gynecologic oncology remains limited. Studies from the United States and Germany have shown low real-world adoption rates during the COVID-19 pandemic, potentially due to infrastructural deficiencies and regulatory uncertainties [11–13]. In addition, telemedicine’s limitations in conveying sensitive medical information—such as new diagnoses—have been noted both in our study and in the literature [29, 30], underlining the need for a careful integration of digital services into emotionally charged clinical workflows.

The pandemic served as a catalyst for increasing telemedicine awareness and acceptability across medical disciplines [16–18]. The integration of telemedicine into Enhanced Recovery After Surgery (ERAS) programs has already shown clinical and economic benefits [2–4, 33]. However, successful implementation requires addressing patient-specific factors such as technological literacy and emotional readiness [15, 19, 25].

Recent studies emphasize the potential of mobile applications and electronic health programs to improve postoperative recovery and reduce healthcare utilization [7, 14, 20, 21, 24]. Furthermore, telemedicine offers benefits such as knowledge exchange in palliative care settings [26] and can enhance patient empowerment when appropriately designed [20, 21]. Nevertheless, equitable access and maintenance of the patient-physician relationship must remain priorities [16, 22, 23].

The future success of telemedicine in gynecologic oncology hinges on nuanced, patient-centered application, rigorous evaluation of digital interventions, and continuous adaptation to emerging evidence [25, 28, 33]. Building on the lessons from COVID-19 [17, 18, 32], telemedicine should be seen as a complementary tool rather than a replacement for face-to-face care [8, 9, 12, 13, 29].

In conclusion, perioperative telemedicine is broadly accepted among patients undergoing surgery for female malignancies. Acceptance depends on age, digital competence, and the sensitivity of the clinical context. Sustainable implementation requires patient-tailored approaches, ensuring high-quality, equitable, and empathetic care.

Limitations of the study

The voluntary nature of participation and the requirement to complete a German-language questionnaire may have led to selection bias, underrepresenting older or digitally less experienced individuals. While the custom questionnaire offered content relevance, it lacked formal psychometric validation. The absence of qualitative data limited exploration of emotional concerns underlying telemedicine rejection. Moreover, the focus on oncologic surgery patients restricts generalizability to other populations, and self-reported digital behavior may not accurately reflect actual digital literacy.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Conceptualization, Sascha Hoffmann and Christina Barbara Walter; methodology, Sascha Hoffmann and Tobias Engler; investigation, Rebekka Hieber and Tobias Engler; writing-review and editing, Sascha Hoffmann and Tobias Engler; All authors have read and agreed to the published version of the manuscript.

Funding

Open Access publication fee (APC) for this article was covered by an agreement between the German Society for Gynecology and Obstetrics (DGGG) and Springer Nature.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Conflict of interest

The authors declare no competing interests.