Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study. (Preprint)

BACKGROUND Online Patient-Provider Communication (OPPC), using online-based tools, including email/internet, tablets/smartphones, and mobile apps, for patient-provider communication, is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited. OBJECTIVE Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and those without a history of cancer during COVID vs. pre-COVID. METHODS Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 2,579) and adults without a history of cancer (n= 13, 292). COVID data was collected from January to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (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 (OR) and 95% confidence intervals (95% CI). RESULTS The average prevalence of OPPC increased from pre-COVID (2017-19) to COVID (2020) among cancer survivors (39.1% vs. 51.3%, email/internet; 29.3% vs. 39.1%, tablet/smartphone; 18.9% vs. 29.9%, EHR). Cancer survivors were more likely to use OPPC than adults without a history of cancer during COVID. During COVID, subgroups of cancer survivors, including racial/ethnic minorities, or those with the low income (OR=3.69, 1.12-12.21 $50,000 to <$75,000 vs. <$20,000), or reporting depression (OR=0.44, 0.20-0.98) were less likely to use email/internet and those who were unmarried (OR=2.44, 1.21-4.91 married vs. unmarried) or had public/no health insurance (vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors without a usual source of care were significantly less likely to use e-mail/internet (OR=4.77, 1.41-16.18) or EHR (OR=6.63, 1.51-29.06). While not observed in cancer survivors, lower education level and older age were associated with lower OPPC among adults without a history of cancer during COVID. CONCLUSIONS Our findings identified subgroups of cancer survivors who were left behind in OPPC, communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. CLINICALTRIAL N/A