A survey to evaluate patients’ perspective concerning e-mail in an oncology practice

Abstract

Purpose: Use of e-mail to improve physician-patient communication is becoming increasingly widespread, however, little research has been done to evaluate patients’ interest and concerns regarding this technology. The goals of this study were to (1) evaluate the effectiveness of e-mail for communication between patients and their oncologist and (2) assess from the perspective of the patient the accessibility and usefulness of e-mail to facilitate medical treatment and advice as compared to conventional mail and telephone. E-mail as a clinical tool is a new trend in medicine that is growing quickly, however, there are few reports to date that evaluate the patients’ perspective concerning e-mail usage. The use of e-mail in doctor-patient communication is potentially faster and more efficient than conventional mail and may reduce “telephone tag”. E-mail initiated by the physician also allows for potential follow-up after treatment. Our study evaluated the types of transactions (personal medical questions, referrals, etc.) for which patients’ preferred using e-mail in place of conventional communication methods. Materials and Methods: A self-administered survey (8 pages; 50 items) was mailed to 65 patients who were treated within the previous three years for prostate cancer in a radiation oncology practice. This survey explored the opinions and behaviors of patients with regard to online communication about general healthcare issues. The items included: patients’ interest in e-mail, comfort in using e-mail, concerns about confidentiality, and access to e-mail. Patients’ interest in using e-mail for specific situations were also evaluated, such as, making appointments, following up on treatment, or asking general health related questions. Patients’ concerns about using email to communicate with healthcare organizations also were assessed. Results: The response rate to the survey was 63%, with a median age of 68 years (range 53-82), and the majority of respondents were white (94%) with 6% African American. Sixty-four percent or respondents had access to an e-mail account at home or work. Among these e-mail users, 66% were between the ages of 58-68, and 34% were more than 68 years old. Eight-one percent of email users had completed some or all of college, and 19 % had completed some or all of high school. The majority of patients indicated that the benefits of e-mail were to eliminate phone calls (70%), to increase the timeliness of a message (81%), to arrange appointments (73%), to ask a physician health related questions (79%), to refill prescriptions (64 %). Only one-third of patients felt e-mail to be appropriate to ask urgent health questions. Most patients (72%) felt comfortable responding to health questions sent by their doctor by e-mail. When controlling for age within this group 57% of patients who preferred e-mail were under 68 years old and 43% of patients were over 68 years old. When evaluating education level, 64% of the patients that preferred using email had a college or graduate degree and 36% had completed some or all of high school. More than half of respondents (61%) felt comfortable answering questions via e-mail that were posed to them by someone in their doctor’s office, such as, a nurse, or physician’s assistant. Patients were evenly divided when asked about confidentiality (56% unconcerned). Conclusion: This study demonstrated that patients were interested in using e-mail in non-urgent situations and to improve the timeliness of communication. Patients preferred e-mail for increased convenience and efficiency regarding minor health problems and did not prefer it for answers to more urgent health questions. Patients with at least a college degree were inclined to use e-mail over those who had completed some or all of high school. Patients who were not currently using e-mail responded favorably to the notion of communicating via e-mail with their physician and/or physician’s staff. Our survey revealed that patient’s may prefer using email for some aspects of communication with their physician. E-mail has the potential to be integrated into a radiation oncology practice.