Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study
Authors: Kim Jiyeong , Linos Eleni , Fishman Debra A , Dove Melanie S , Hoch Jeffrey S , Keegan Theresa H 
Published: April 2023

Background
Online patient-provider communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS-CoV-2/COVID-19, yet investigations in vulnerable subgroups have been limited.

Objective
This study aims to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID-19 versus pre–COVID-19.

Methods
Nationally representative cross-sectional survey data (Health Information National Trends Survey 5, 2017-2020) were used among cancer survivors (N=1900) and adults without a history of cancer (N=13,292). COVID-19 data included data from February to June 2020. We calculated the prevalence of 3 types of OPPC, defined as using the email/internet, tablet/smartphone, or electronic health record (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (ORs) and 95% CIs.

Results
The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs 49.7%, email/internet; 32.2% vs 37.9%, tablet/smartphone; 19.0% vs 30.0%, EHR). Cancer survivors (OR 1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID-19. Among cancer survivors, the email/internet (OR 1.61, 95% CI 1.08-2.40) and EHRs (OR 1.92, 95% CI 1.22-3.02) were more likely to be used during COVID-19 than pre–COVID-19. During COVID-19, subgroups of cancer survivors, including Hispanics (OR 0.26, 95% CI 0.09-0.71 vs non-Hispanic Whites) or those with the lowest income (US $50,000-<US $75,000: OR 6.14, 95% CI 1.99-18.92; ≥US $75,000: OR 0.42, 95% CI 1.56-11.28 vs <US $20,000), with no usual source of care (OR 6.17, 95% CI 2.12-17.99), or reporting depression (OR 0.33, 95% CI 0.14-0.78) were less likely to use email/internet, and those who were the oldest (age 35-49 years: OR 9.33, 95% CI 2.18-40.01; age 50-64 years: OR 3.58, 95% CI 1.20-10.70; age 65-74 years: OR 3.09, 95% CI 1.09-8.76 vs age≥75 years), were unmarried (OR 2.26, 95% CI 1.06-4.86), or had public/no health insurance (Medicare, Medicaid, or other: ORs 0.19-0.21 vs private) were less likely to use a tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR 6.23, 95% CI 1.66-23.39) or health care office visits in a year (ORs 7.55-8.25) were significantly more likely to use EHRs to communicate. Although it was not observed in cancer survivors, a lower education level was associated with lower OPPC among adults without a history of cancer during COVID-19.

Conclusions
Our findings identified vulnerable subgroups of cancer survivors who were left behind in OPPC, which is increasingly becoming part of health care. These vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities.