Table 2 Thematic framework: Themes, COM-B categories and subthemes supported by example quotations

Telehealth enables remote access to cancer pain management but also creates a digital divide

Physical opportunity

Telehealth enables remote access to healthcare

“…the telehealth helps. I mean, it’s almost better in some ways, the patient doesn’t have to go all the way to their GP [general practitioner] or to the surgeon.” (C12, Clinical Nurse Consultant)

“…it is a very useful tool when people can’t come in, and it’s good for country patients because before they would have to come down to Sydney.” (C23, Clinical Nurse Consultant)

Telehealth limits the ability of clinicians to assess and examine patients

“Because you can’t see them in person and it’s hard to assess how well someone is through video conference.” (C08, oncology Junior Medical Officer)

Psychological capability

Difficulty using telehealth to assess pain experienced by patients

“…[I] don’t have the same rapport or the same therapeutic relationship. I think there’s a lot you can get from just seeing a patient within just a few seconds. You can see how well they’re doing, how their pain is.” (C15, palliative care registrar)

Communication over telehealth is limited

“I think it can be hard for patients to explain their [pain] experiences over telehealth” (C09, Junior Medical Officer)

“It’s much harder to appear genuine or empathic or invested in listening when you’re online or even on a telephone. It’s just another voice on the end of the line.” (C14, anaesthetic specialist)

“A lot of the telehealth that I’ve provided has been just the old-fashioned telephone. So, there’s been no video calling, it’s just been a conversation over a telephone, and that can be improved.” (C14, anaesthetic specialist)

Challenges transferring clinical skills to telehealth

“So, the biggest change has been getting better at assessing through a non-face-to-face method.” (C13, anaesthetic registrar)

Lack of patient skills using telehealth technology

“…when you’re dealing with an older demographic that perhaps… don’t understand how to do things a bit more virtually and use technology.” (C07, music therapist)

Access to cancer pain management in the community is compromised due to the pandemic

Physical opportunity

Limited access to face-to-face appointments with general practitioners

“…medical centres and GPs [general practitioners] have been closed, or only doing remote stuff.” (C19, anaesthetic specialist)

Limited access to community health services impacts timely management

“…a lot of clinical nurse consultants were taken out of their regular roles, which is outreach to patients in the community and made to work in different departments …so those patients that they were normally following up with, cancer patients or other patients, have missed that follow up…” (C21, Nursing Unit Manager)

COVID-19 negatively impacts hospital resource allocation

Physical opportunity

Impact of COVID-19 restrictions on elective surgery for cancer pain

“So, what has happened is that elective lists have been cancelled. And amongst that interventional pain lists are part of the elective process. So, something like cancer pain management, I think should be prioritised because of the significant impact that they can have on their care.” (C13, anaesthetic registrar)

Prioritisation of beds for COVID-19 management

“Beds have been short because even in the cancer hospital there’s been an overflow of general patients from the main hospital that required beds for management and treatment of their COVID.” (C14, anaesthetic specialist)

Redeployment of hospital staff

“There were a lot of staff changes lately due to redeployment.” (C17, pain management specialist)

Patients were required to trade off cancer pain management against other health priorities

Reflective motivation

“I think it was just mainly fear that they’re going to come in and they’re going to catch COVID off either a staff member or another patient.” (C04, Enrolled Nurse)

“…there’s been a lot of COVID fear… And that has actually stopped people from going to emergency with pain.” (C12, Clinical Nurse Consultant)

Hospital restrictions result in decreased social and psychological support for patients with cancer pain

Social opportunity

“I think that, from the psychological side, all the patients just get more and more isolated…they’re more miserable. They have less access to family.” (C18, intensivist registrar)

“…because of personal protective equipment and isolation requirements, families might not be there, so they’re psychologically more isolated.” (C10, Junior Medical Officer)