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.
Original language | English (US) |
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Pages (from-to) | 476-484 |
Number of pages | 9 |
Journal | Journal of the National Cancer Institute |
Volume | 116 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2024 |
Funding
The IMPACT Consortium is a Cancer Moonshot Research Initiative under the authorization of the 2016 21st Century Cures Act. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award No. UM1CA233033 (Mayo Clinic, Rochester, MN), UM1CA233035 (Northwestern University, Chicago, IL), UM1CA233080 (Baptist Health System, Memphis, TN; Dana-Farber Cancer Institute, Boston, MA; Dartmouth Hitchcock Medical Center, Lebanon, NH; Lifespan Health System, Providence, RI; Maine Medical Center, Portland, ME; and West Virginia University, Morgantown, WV), and U24CA232980 (RTI International, Research Triangle Park, NC).
ASJC Scopus subject areas
- Oncology
- Cancer Research