Association between Patient Portal Usage and Perceived Patient-Centered Communication among Adults with Cancer: Cross-Sectional Survey Study (Preprint)

Abstract

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 the use of patient portals may improve perceived PCC or which mechanisms might mediate this relationship has not been studied.

The primary goal of this study was to investigate the association between the frequency of access to patient portals and perceived PCC in patients with cancer. A secondary goal was to explore whether this association was mediated by patients' self-efficacy in health information seeking.

We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). The present analysis includes 1,222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS derived scale and classified as low, medium, or high. Patient portal usage was measured by a single item assessing the frequency of use. Self-efficacy about health information seeking was assessed with a one-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRR) of the association between patients' patient portal usage and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson, Holm, and Breen methods.

54.5% of the sample reported that they did not access their patient portals in the past 12 months, 12.6 % accessed it 1-2 times, 24.8% accessed it 3-9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=0.06) 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 (ten 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.

PCC is an integral part of patient-centered care. Those who reported the greatest use of patient portals were more likely to report higher perceived PCC. These findings emphasize the importance of encouraging cancer patients and providers to use patient portals to increase patient-centeredness of care and suggest that interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.