Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

Abstract

Background Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. Objective The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients’ self-efficacy in health information–seeking. Methods We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5–derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information–seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. Results A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information–seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use. Conclusions Increased frequency of patient portal use was associated with higher PCC, and an individual’s health information–seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.

The association between electronic health information usage and patient-centered communication: a cross sectional analysis from the Health Information National Trends Survey (HINTS)

“…This may indicate that patient-provider direct communication is important. Private eHealth use focused on the patient portal use in HINTS, and patient portal use is associated with positive PCC in the literature [ 25 ]. On the contrary, public eHealth with no restricted information and no focused communication target, often acted as an adjunct means to obtain needed health information.…”

“…Similar findings have been reported in past studies. Individuals’ PCC has been positively associated with personal health record use (e.g., patient portal) [ 25 , 33 ]. Patients who used a patient portal more frequently tended to have better self-management behavior especially among ones with multimorbidity [ 19 , 34 ].…”

“…At present, relevant literature is mixed in their results and conclusions. Some studies report a positive association between eHealth usage (i.e., personal health record use) and PCC, [ 25 , 26 ] while other studies reported a negative association between eHealth usage (i.e., telemedicine, searching publicly available health-related information) and PCC [ 13 , 27 ].…”

Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis

“…HIT is not able to incorporate emotional experiences, even though it may change with wider adoption of artificial intelligence in the health care universe [ 61 ]. Instead, it is a facilitator of engagement behaviors that could potentially bridge socioeconomic and communication gaps [ 36 , 62 , 63 ]. Even when patients mostly rely on medical professionals for medical knowledge regarding their diagnosis and treatment [ 64 ], those with better access to medical information technology support have a more positive attitude toward engaging in medical decision-making, as it helps in relative information seeking to relieve anxiety [ 65 , 66 ].…”

“…Although further research is needed on the use of HIT among older adults diagnosed with cancer, it has been observed that these patients tend to demonstrate higher levels of activation and engagement in their health care. This can be attributed to the existing body of literature that underscores the advantages of HIT and the supportive role played by oncology health care providers [ 32 - 36 ]. Therefore, to investigate the influence of HIT use in older adults, we examined specific sociodemographic and psychosocial factors of fatalistic beliefs while accounting for the potential impact of a cancer diagnosis, which might affect their level of engagement.…”