Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".