Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS: Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS: Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION: Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
DOI: 10.1093/jnci/djad225
Authors: Joan M Griffin, Barbara L Kroner, Sandra L Wong, Liliana Preiss, Ashley Wilder Smith, Andrea L Cheville, Sandra A Mitchell, Nicola Lancki, Michael J Hassett, Deborah Schrag, Raymond U Osarogiagbon, Jennifer L Ridgeway, David Cella, Roxanne E Jensen, Ann Marie Flores, Jessica D Austin, Betina Yanez
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,978
Funders: U.S. Department of Health and Human Services, Hitchcock Foundation, American Society of Clinical Oncology, Memorial Sloan-Kettering Cancer Center, Northwestern University, University of Washington, Dana-Farber Cancer Institute, RTI International, Dartmouth College, West Virginia University, National Institutes of Health, Feinberg School of Medicine, Cancer Institute, West Virginia University, National Cancer Institute, Moonshot Research and Development Program, Cancer Moonshot
Awards: G1341250727, G1350817879, G1688401713, Enhanced, EHR-facilitated Cancer Symptom Control (E2C2) Pragmatic Clinical Trial, G5019006246, Coordinating Center for Research Centers for Improving Management of Symptoms During and Following Cancer Treatment, G6136445202, Implementation and Evaluation of an Expanded Bilingual Electronic Symptom Management Program across a Multi-site, Fully-integrated Comprehensive Cancer Center, G6762802350, G7182768446, G8064078703, G9000023649, Cancer Center Support Grant
OpenAlex ID: W4388410049