Patient Portal Research Articles

Insights into missing populations: Exploring characteristics of unscreened patients with cancer in psychosocial distress and social drivers of health screening in an ambulatory setting.

174 Background: Psychosocial distress is common among patients with cancer and distress screening is required for American College of Surgeons Commission on Cancer accreditation. Screenings proactively identify needs, connect patients to services, reduce distress and improve cancer outcomes. We implemented a dynamic 17-question electronic screening tool that includes: assessment for psychosocial distress, social drivers of health (SDH) and spiritual care, and evaluated differences in patient characteristics among those who did and did not complete the survey. Methods: The survey was developed through an interdisciplinary review of evidence-based questions to proactively address supportive care needs for patients. It is available in English and Spanish and sent to patients via the patient portal 7 days before the second oncology appointment with a reminder 3 days before the appointment. It was implemented across 5 Mount Sinai Health System ambulatory facilities, spanning 3 New York City boroughs between June 2022 and February 2024. We used descriptive statistics to compare demographic and clinical characteristics of patients who did and did not complete the survey. Results: A total of 11,199 patients were assigned surveys; (42%) did not complete it. Patients who did not complete the survey were more likely to be Asian and Hispanic, older age, to speak a language other than English, reside in Queens or Brooklyn, and were less likely to have Commercial insurance compared to those who completed the survey (p<0.001 for all). There was no difference in sex (p=0.93) among the groups. Conclusions: There are significant disparities in the completion rates of electronic psychosocial distress and SDH screenings among patients with cancer, revealing that certain groups are less likely to engage with the tool. Targeted strategies are needed to increase screening completion rates among these populations. Future efforts should focus on addressing language barriers, enhancing technological accessibility, and developing culturally sensitive approaches to ensure all patients benefit from these screenings so we can better identify and address the supportive care needs of all cancer patients. Characteristics of patients who did and did not complete the survey. Characteristic Did Not Complete4654 (42%) Completed6545 (58%) p-value Race <0.001 Black 978 (21) 1538 (23) Asian 642 (14) 698 (11) Unknown 225 (5) 258 (4) Other/Patient Declined 1298 (28) 1461 (22) White 1511 (32) 2590 (40) Age (mean (SD)) 64 (14) 61 (15) <0.001 Non English Language 1167 (25) 956 (15) <0.001

Feasibility of a digital palliative care intervention (Convoy-Pal) for older adults with heart failure and multiple chronic conditions and their caregivers: a waitlist randomized control trial

BackgroundAlthough older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers.MethodsA randomized waitlist control feasibility trial involving patients over 65 years old with MCC who had been hospitalized two or more times for HF in the past 12 months and their caregivers. Descriptive statistics were used to evaluate recruitment, retention, missing data, self-reported social functioning, positive aspects of caregiving, and the acceptability of the intervention.ResultsOf 126 potentially eligible patients, 11 were ineligible and 69 were deceased. Of the 46 eligible patients, 31 enrolled in the trial. Although 48 caregivers were identified, only 15 enrolled. The average age was 76.3 years for patients and 71.6 years for caregivers, with most participants being non-Hispanic White. Notably, 4% did not have access to a personal mobile device or computer. Retention rates were 79% for intervention patients, 57% for intervention caregivers, and 60% for control participants. Only 4.6% of survey subscales were missing, aided by robust technical support. Intervention patients reported improved social functioning (SF-36: 64.6 ± 25.8 to 73.2 ± 31.3) compared to controls (64.6 ± 27.1 to 67.5 ± 24.4). Intervention caregivers also reported increased positive perceptions of caregiving (29.5 ± 5.28 to 35.0 ± 5.35) versus control caregivers (29.4 ± 8.7 to 28.0 ± 4.4). Waitlist control participants who later joined the Convoy-Pal program showed similar improvements. The intervention was well-rated for acceptability, especially regarding the information provided (3.96 ± .57 out of 5).ConclusionsRecruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users.Trial registrationClinicalTrials.gov Identifier NCT04779931. Date of registration: March 3, 2021.

Implementation of hereditary cancer risk assessment in primary care: Intervention strategies and proximal outcomes.

279 Background: Family history-based risk assessment for hereditary breast and ovarian cancer and Lynch syndrome is guideline recommended and has strong evidence supporting its implementation into clinical practice, especially primary care. Yet, adoption has been impeded by limited awareness of genetic evaluation guidelines among primary care providers (PCPs), time constraints in screening during appointments, and limited resources for follow-up within primary care. To close this gap, we implemented a hereditary cancer risk assessment program that addresses these barriers and evaluated proximal implementation outcomes. Methods: We used intervention mapping for adaptation (IM-Adapt), a modified version of Intervention Mapping to guide the adaptation and implementation of the evidence-based 7-question family history screening (FHS-7) at a primary care clinic within an academic medical center. FHS-7 was adapted for administration via electronic patient portal prior to PCP visit or in-person at PCP visit. All clinic patients were offered screening and follow-up genetic counseling and testing per guidelines. Administrative, programmatic, and electronic medical record data were analyzed for program evaluation. Results: Between February 2023 and March 2024, 4,540 primary care patients were offered hereditary cancer risk assessment and 3,497 (77%) completed screening. Patient portals were used to complete screening more frequently than in-person at the clinic (86.6% vs 13.4%). Among patients with qualifying family history of cancer (n=1,267, 36%), 1,117 (88%) were eligible for navigation as they completed their primary care appointment and did not undergo genetic counseling within the last 5 years. Of the eligible patients, 62% were successfully contacted by a navigator and offered genetic counseling. Program implementation was facilitated by key personnel (clinical champion, informatics staff, genetic patient navigator) and adaptations to fit the implementation setting (adapting FHS7 for patient self-report rather than administration by PCP, patient population with high patient-portal adoption rate and in-house genetic service resources). Conclusions: We demonstrate the feasibility of hereditary cancer risk assessment within primary care and describe actionable aspects of the implementation context that influence screening uptake that can be incorporated into the design of future implementation for maximum impact. Findings advance the state of science in identification of unaffected individuals with inherited cancer susceptibility and genetic service delivery.

Leveraging the electronic health record patient portal to enhance clinical trial recruitment.

387 Background: The increasing prevalence of video/remote visits in the clinical setting has posed researchers with unique challenges related to clinical trial recruitment. Without the ability to speak to potential participants face to face, researchers rely on making phone calls which are frequently screened, declined, or never returned. Patients contacted in this way may never access the trials and care opportunities available to them. Electronic health record (EHR) patient portals, such as MyChart (Epic), allow individuals to access their medical records and communicate with their providers via instant messaging. This EHR tool may offer researchers a new method of participant recruitment to clinical trials. Methods: An electronic report, built around the Five- or Ten-Year Colonoscopy Trial’s (FORTE/NRG-CC005) eligibility criteria, was used to identify potential study participants. The local research team then generated an investigator endorsed, IRB-approved introductory script to send to patients via the MyChart instant messaging function. Once delivered, the message status was monitored to determine whether the patient had opened/read the introductory message. Patients who responded and expressed interest in trial participation were then sent additional information through MyChart and asked to schedule a time to speak to research staff over the phone. Results: In the two years that the FORTE trial was opened at our institution (October 2021 to August 2023), prior to implementing this MyChart practice, the research team attempted to contact 108 eligible patients via outreach phone calls. Of the 108, only 10 were reached by the study team and 0 consented to the trial. Between August 2023 and May 2024, 28 eligible patients were sent the MyChart script resulting in a response rate of 85.7% (24/28). Of the respondents, 20.8% (5/24) declined participation and did not want additional study information; 41.7% (10/24) requested more information but later declined participation, and 37.5% (9/24) expressed interest in trial participation. To date, of these 9 interested patients, 4 have enrolled to FORTE, and 5 are in the screening process. Conclusions: Preliminary observations suggest that recruiting patients to clinical trials through an electronic health record portal is an effective tool for enhancing enrollment. Further research is warranted to prospectively evaluate this recruitment strategy.

Association between food insecurity, financial toxicity, and healthcare utilization in adolescents and young adults with cancer.

305 Background: Adolescents and young adults with cancer experience high rates of financial toxicity (FT) and unmet health-related social needs (HRSN: food, housing, transportation insecurity). FT and unmet HRSN, specifically FI, are modifiable factors that impact health outcomes; however, the relationship between FI, FT, and healthcare utilization (emergency department (ED) visits or hospitalizations) remains unclear. Leveraging systematic screening for FT and HRSN using the electronic health record (EHR) patient portal among AYAs with cancer, we examined the association between FI, FT, and healthcare utilization measures among AYAs with cancer. Methods: AYAs (ages 15-39) who utilize the EHR patient portal were prompted to complete an 8-item standardized HRSN survey (i.e., food insecurity, housing instability, transportation difficulties) and a 2-item previously established FT survey during e-check in between November 2022 and April 2024. ED visits and hospitalizations were extracted from the EHR directly. Descriptive statistics and associations using chi-square tests were used to describe the patients and examine associations between FI or FT and ED visits or hospitalizations. Results: Of 691 AYAs who completed the HRSN survey, 16% (n=109) screened positive for FI. Among AYAs with FI, 42% (n=46) had at least one ED visit compared with 28% (n=163) among AYAs without FI (p<0.01). Among AYAs with FI, 39% (n=43) were hospitalized at least once compared to 31% (n=179) among AYAs without FI (p=0.07). Of 439 AYAs who responded to the FT survey, 66% (n=290) met criteria for high FT. Within this group, 26% (n=74) had at least one ED visit compared with 17% (n=26) who screened negative (p=0.06). Among AYAs with high FT, 22% (n=65) were hospitalized at least once, compared with 19% (n=28) among those with low or moderate FT (p=0.38). Among 384 AYAs who responded to both the HRSN and FT surveys, 19% (n=74) screened positive for FI, 92% (n=68) of whom also had high financial toxicity. The table describes characteristics of screened AYAs by language and race/ethnicity. Conclusions: FI may be a risk factor for increased ED visits during cancer treatment among AYAs. Systematic screening to identify FI, FT, and other HRSN is important to facilitate referral for resources, support services, or interventions. Sociodemographic characteristics of AYA participants in FI and FT screening. Characteristic +FI -FI +FT -FT N=109 (%) N=582 (5) p-value N=290 (%) N=149 (%) p-value Language <0.01 <0.01 English 82 (75) 496 (85) 241 (83) 134 (90) Spanish 24 (22) 45 (8) 29 (10) 1(1) Other 3 (3) 41 (7) 20 (7) 14 (9) Race/Ethnicity <0.01 <0.01 Hispanic, any race 67 (61) 175 (30) 125 (43) 16 (11) Non-Hispanic Black 12 (11) 62 (11) 30 (10) 10 (7) Non-Hispanic White 16 (15) 219 (38) 78 (27) 84 (56) Other 14 (13) 126 (22) 57 (20) 39 (26)

Implementation of telemonitoring for home PN patients using the digital patient portal of the hospital: Empower the patients

Implementation of telemonitoring for home PN patients using the digital patient portal of the hospital: Empower the patients

Can Digital Health Improve Therapeutic Compliance in Oncology?

Therapeutic compliance, or adherence, is critical in oncology because of the complexity and duration of cancer treatment regimens. Nonadherence can lead to suboptimal therapeutic outcomes, increased disease progression, higher mortality rates, and elevated health care costs. Traditional methods to enhance compliance, such as patient education and regular follow-ups, have shown limited success. This review examines the potential of digital health technologies to improve adherence in oncology. Various studies and trials are analyzed to assess the effectiveness of these technologies in supporting patients with cancer. mHealth applications have been shown to improve medication adherence through features like medication reminders and symptom tracking. Telemedicine facilitates continuous care and reduces the need for travel, significantly improving adherence and patient satisfaction. Patient-reported outcome measures enhance clinical decision making and personalized treatment plans by incorporating patient feedback. Electronic medical records and patient portals improve compliance by providing easy access to medical information and fostering better patient-provider communication. Connected pillboxes aid in consistent medication intake and reduce dispensing errors. Digital health technologies offer significant benefits in oncology by enhancing patient engagement, improving adherence to treatment protocols, and enabling comprehensive cancer care management. However, challenges such as the digital divide, data privacy concerns, and the need for tailored interventions must be addressed. Future research should focus on evaluating the effectiveness of digital interventions and developing personalized digital health tools to maximize therapeutic compliance.

How quickly do patients with cancer view the results of their imaging studies?

419 Background: The 21 st Century Cures Act requires electronic health data to be available to patients. However, such data are useful to patients only if they access it. For example, imaging data can indicate the effectiveness of treatment and progression of disease and engagement with this information empowers patients to become more active in their care. While prior studies have explored the prevalence and timing of patient access to clinical notes, the timing of patient access to other data types remains unknown. We analyzed how rapidly oncology patients access the results of their imaging studies. Methods: Memorial Sloan Kettering Cancer Center (MSK) is a cancer center in New York that provides 700,000 imaging studies annually. At the time of this analysis, MSK had an internally developed patient portal, MyMSK, which notified patients via email about the presence of new data in the portal. The default timing for notifications was daily at 8 a.m. (patients could change notifications to be real-time, but very few did). We selected an arbitrary 7-day period (4/1/2023-4/7/2023) for analysis. For that week, for all imaging studies performed at MSK, we measured the time from when the report was available in the database (and thus available to the patient in MyMSK) to the time the report was read by either a patient or a proxy. The day the imaging study was performed was defined as “Day 0”. We determined (i) the proportion of imaging study reports that were read by 8 a.m. on Day 1, i.e., before any notification was sent to the patient, (ii) the proportion of reports that were read on Day 1 between 8 a.m. and 5 p.m., (iii) the proportion of reports that were read after 5 p.m. on Day 1, and (iv) the proportion not yet read by 8/23/2023 (when the data were collected). Results: In this one-week period, a total of 7,110 patients had 10,298 imaging studies. The average age of the patients was 61.4 years, 61.3% were female, 85.5% were non-Hispanic, 75.8% were White, and 95.1% reported English as their preferred language. Of the 10,298 imaging reports, 3203 (31.1%) were read before 8 a.m. on Day 1, 2090 (20.3%) were read between 8 a.m. and 5 p.m. on Day 1, 2389 (23.2%) were read after 5 p.m. on Day 1, and 2616 (25.4%) were not read as of 8/23/2023. Conclusions: This analysis indicates that a substantial proportion of cancer patients seek the results of imaging studies very soon after the tests are performed. Almost a third of the time, the patient read the report before any notification arrived. In oncology, it is easy to imagine patients frequently refreshing their portal to see if results have been posted. It is vital for provider organizations to understand the eagerness with which patients await results. Organizations may also want to develop methods to answer questions patients may have about their results prior to speaking with providers; this may be a key opportunity to leverage emerging artificial intelligence techniques.

Association between food insecurity and healthcare utilization among patients at a breast oncology center.

143 Background: A breast cancer (BC) diagnosis often creates or exacerbates financial stress. As a result, many patients with BC struggle with a lack of consistent access to nutritious food due to limited resources, a condition termed “food insecurity” (FI). We investigated the association between FI and healthcare utilization among breast oncology patients at our urban academic medical center. Methods: Screening for health-related social needs (HRSN) was conducted primarily through the electronic patient portal, at appointment registration for a breast oncology clinic visit. The 8-item HRSN survey included 2 questions on access to food resources and 1 question quantifying emergency department (ED) visits over the past year. Any level of food hardship or concern constituted a positive FI screen. We conducted a retrospective analysis among patients evaluated between 11/2/22 and 4/20/24. Clinical and demographic data were obtained from the electronic health record (EHR). We evaluated the association between FI and health care utilization measures (ED visits, inpatient admissions) with a Pearson's Chi-squared test and univariate logistic regression. Results: A total of 2820 patients were screened for HRSN and provided responses to at least 1 FI question, of which 19.7% (555) reported some level of FI. Food-insecure patients self-reported significantly higher rates of ED visits in the past 12 months compared to food-secure patients: 43.2% vs 22.6% reported at least 1 ED visit, respectively (p<0.001), and 25.0% vs 8.45% reported multiple ED visits, respectively (p<0.001). Overall, FI was associated with 2.5 times the odds of self-reporting at least 1 ED visit (univariate OR 2.47, p<0.001). Similarly, on review of EHR data, 33.3% of food-insecure patients had at least 1 ED visit (vs 20.0% of food-secure patients, p<0.001), and 6.13% had 3 or more ED visits (vs 2.83%, p<0.001) during the study period. On univariate analysis, food-insecure patients had double the odds of having at least 1 ED visit documented in the EHR (univariate OR 2.00, p<0.001). We examined reasons for ED presentations among 186 food-insecure patients with ED visits during the study period, and found that 23.8% had at least 1 cancer-related complaint (oncological treatment-related (16.8%) and/or BC symptom-related (8.6%)). The incidence of inpatient admissions during the study period was similar among food-insecure vs food-secure patients (19.8% vs 18.4%, p=0.467). Conclusions: In this analysis of FI and health care delivery measures, ED utilization was significantly higher among food-insecure patients. A quarter of food-insecure patients who presented to the ED had oncological complaints. FI may be a marker of unmet healthcare needs in patient with cancer, and targeted interventions focused on symptom monitoring and management are warranted to optimize healthcare utilization.

Characterization of Electronic Medical Record Patient Portal Messaging and the Impact of the COVID-19 Pandemic: A Single Institution Experience

Characterization of Electronic Medical Record Patient Portal Messaging and the Impact of the COVID-19 Pandemic: A Single Institution Experience

The association of oncology telehealth visits with acute care events and follow-up appointments.

384 Background: Use of telehealth visits in cancer care expanded with the pandemic, yet few studies have assessed its impact on subsequent care outcomes. We evaluated differences in acute care events (ACEs) and follow-up visits among patients with telehealth compared to in-person oncology visits. Methods: We identified a cohort of adults with an upcoming oncology visit related to their cancer treatment at two academic medical centers (in central NC and southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled. Pre-visit surveys administered by telephone collected information on sociodemographic characteristics, prior telehealth use, health status/symptoms and travel distance. We joined survey and electronic health record (EHR) data and used geocoding to assign census-tract-level community characteristics to participants. ACE and follow-up visit use were ascertained via the EHR. Unadjusted and adjusted prevalence differences in ACEs within 30 and 180 days as well as follow-up visits within 7 and 30 days were assessed by visit type. Results: 502 patients were study eligible, 90 telehealth and 412 in-person visits. In unadjusted and adjusted models, the proportion of patients incurring an ACE within 7 and 30 days was not significantly different (6 vs. 3% and 17 vs. 10%, telehealth vs. in-person, respectively). Nor did the proportion of patients having a follow-up visit within 7 or 30 days differ significantly (26 vs. 20% and 65 vs. 54%, telehealth vs. in-person, respectively). Some patient characteristics were similar regardless of visit format. For example, most patients were older (63 mean age SD 13), not currently employed (66%), and reported getting by/living comfortably with current income (88%), having some college education (80%), no transportation troubles (85%), and activated patient portal accounts (89%). Symptom presentation per the PRO-CTCAE was similar between groups as was broadband connectivity. Telehealth patients were significantly less likely to be Black (14 vs. 44%), female (48 vs. 72%), have breast cancer (22 vs. 48%), received chemotherapy (72 vs. 83%), or to live within 60 minutes of care (49 vs. 68%), and more likely to have advanced disease (24 vs. 14%), report LGBTQ sexual orientation (10 vs. 4%), and be married (70 vs. 57%). Conclusions: Similar ACE and follow-up visit use among those with telehealth and in-person visits supports the idea that telehealth could be a viable substitute for some in-person care within oncology. Differences between those using telehealth and in-person visits highlight equity concerns and missed opportunities to enhance patient convenience and other aspects of care access. To better understand telehealth’s impact, not only on care use, but other indicators of quality (including patient outcomes), matching via propensity score analyses are needed and underway.

Characterizing health-related social needs and their association with medication adherence in a diverse cohort of patients with breast cancer.

139 Background: Food insecurity, housing instability, and transportation challenges are modifiable health-related social needs (HRSN) that have been associated with worse health outcomes in patients with cancer. Nonadherence to medications is also associated with decreased survival and other poor outcomes. Less is known about the association between HRSN and medication adherence in this patient population. Methods: We implemented screening for HRSN among breast oncology patients at our urban academic medical center, primarily through the electronic patient portal. Patients were offered an 8-item HRSN survey with questions covering food insecurity, housing, transportation needs, and emergency department visits. Any level of food hardship, housing instability, or transportation challenges reported during the study period (11/2/22-4/20/24) constituted a positive screen for that HRSN. We also screened patients for nonadherence to medications (any medication) using the 3-item DOSE-Nonadherence questionnaire. Pearson's Chi-squared tests and univariate logistic regressions were used to compare differences between subsets. Results: During the 18-month study period, 2945 patients completed at least 1 item on the HRSN questionnaire, of which 765 (26.0%) screened positive for at least 1 HRSN. Among patients who responded to each HRSN domain, 555/2820 (19.7%) screened positive for food insecurity, 374/2650 (14.1%) for housing instability, and 255/2656 (9.6%) for transportation needs. Food-insecure patients also reported more housing (43.1% v 5.6%, p<0.001) and transportation needs (27.7% v 4.0%, p<0.001) compared to food-secure patients. When comparing the cohort of patients who screened positive for at least 1 HRSN vs those who screened negative, there was a higher proportion of Hispanics (55.3% vs 25.1%, p<0.001), non-Hispanic Blacks (15.3% v 10.0%, p<0.001), and Spanish speakers (41.2% v 17.2%, p<0.001). Patients with any HRSN were more likely to self-report medication nonadherence compared to those with a negative HRSN screen (44.2% v 35.3%, OR 1.45, 95% CI 1.18-1.79). When looking at each individual HRSN domain, food-insecure patients were more likely to self-report medication nonadherence than food-secure patients (45.9% v 35.9%, OR 1.51, CI 1.19-1.92); this was also true for patients with housing instability (45.7% v 36.4%, OR 1.47, CI 1.12-1.92) and transportation needs (49.1% v 36.5%, OR 1.68, CI 1.23-2.31). Conclusions: More than a quarter of breast cancer patients self-reported at least 1 HRSN, with food insecurity being most frequently reported. Patients with at least 1 HRSN had 45% increased odds of medication nonadherence. Further research is warranted to understand the financial, social, psychological, and healthcare-related factors that may underlie this association, and to design interventions targeting at-risk cancer populations.

Is patient satisfaction improved with immediate access to test results (ie, through a patient portal)?

Is patient satisfaction improved with immediate access to test results (ie, through a patient portal)?

Patient Portal Utilization Improves Outcomes in Patients with Multiple Myeloma

Patient Portal Utilization Improves Outcomes in Patients with Multiple Myeloma

Evaluation and Optimisation of a Patient Portal Implementation: An Action Research Approach.

Patient portals can support care delivery and have demonstrated mixed impacts on patients, clinicians and health services. These variable impacts are primarily due to barriers to uptake and challenges associated with successfully implementing patient portals. As little is currently known about how implementation barriers can be addressed in practice, this project used an action research approach to evaluate and optimise the implementation of a patient portal in a real-world setting. Whilst the study is ongoing, the preliminary findings are reported in this paper, along with plans to use the findings to improve the portal in the next round of the action research cycle.

Abstract B037: Reach of digital interventions to address disparities in repeat lung cancer screening in Washington State

Abstract Lung cancer is the leading cause of cancer morbidity and mortality in the United States. Annual screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, annual adherence to screening is suboptimal. To improve annual adherence to lung cancer screening (LCS), additional patient education beyond shared-decision making is needed to normalize the screening process. Interventions which leverage digital modes of delivery might have broad reach, but only if patients actively engage with messages from clinical providers. Furthermore, there may be disparities in access to digital communication by patient demographics which will need to be addressed to advance health equity through digital technology. The objective of this study was to understand factors associated with engagement with patient portal messaging. This study was nested within a pragmatic clinical trial to test the “Patient Voices Video” relative to usual care to determine if participants opened video intervention communication delivered through the patient portal. The video-based intervention (Patient Voices Video) incorporated patient testimonials to acknowledge LCS receipt, reminds patients they are due in 12 months for next scan, and reassurance to reduce fear of LCS and role of loved ones to support health choices. Study participants were Kaiser Permanente Washington members aged 50-78 years with recent normal LCS scan and were randomized to either Patient Voices Video or usual care. Study analyses were restricted to those assigned to video arm. Participants randomized to the video arm received a web link via a patient portal message 3 weeks after normal scan. We generated descriptive statistics to summarize differences in proportions in pre-specified demographic factors associated with opening the video message in the patient portal among those in the video arm and registered in patient portal (n=614). Overall, 85% of participants opened their patient portal message. Patient factors associated with not opening patient portal message included: current tobacco use (currently smoking 56% in group that did not open portal message vs 42% in group that opened portal message) and race/ethnicity (18% non-White in group that did not open portal message vs 10% in group that opened portal message). A higher proportion (8%) of those in non-metro areas opened portal message compared to 3% not opening message. There were no differences in likelihood of opening the portal message by age, sex, prior LCS experience, or area deprivation. Patient portal messages can be a successful delivery mode for LCS interventions with high utilization, but disparities in reach are still prevalent by race and ethnicity and tobacco status. Citation Format: Anjali Vasavada, Lorella Palazzo, Matthew Triplette, Hongyuan Gao, Melissa Anderson, Casey Luce, Yu-Ru Su, James Ralston, Kristine Rogers, Nadia Bezman, Beverly B Green, Lisa Carter-Bawa, Karen J Wernli. Reach of digital interventions to address disparities in repeat lung cancer screening in Washington State [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B037.

Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B046.

Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

BackgroundBack pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.MethodA qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.ResultsCommunity leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.ConclusionCommunity partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers.

Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.

Relationship of Rurality and Confidence in Video Skills With Persistent Nonuse of Video Appointments for Health Care.

Limited research has examined how technology and digital literacy may affect patients' use of video visits. This study explored the relationship of demographic factors and patient-reported confidence in digital literacy skills to access to video visits among patients who never used them during the COVID-19 pandemic. Using existing survey data, the current study examined data from respondents who did not engage in video appointments but instead attended face-to-face appointments between April and December 2020 for nonemergent health concerns. A multivariable logistic regression model was used to investigate whether demographic and social determinants of health factors, context of care (primary care or psychiatry/psychology), and digital literacy confidence were associated with video visit engagement. Collinearity was assessed using the variance inflation factor. This study found that living in rural areas and having a self-reported lack of confidence in logging video appointments using the Mayo Clinic patient portal were associated with persistent nonuse of video appointments in a cohort of patients who did not use video visits at this institution during the early part of the COVID-19 pandemic. The research findings reported herein reveal that individuals living in rural areas and those who lack confidence in logging into patient portals to access video visits tend to persistently avoid using video appointments. More investment is needed at the federal and corporate levels to improve digital connectivity. Digital navigators and community involvement can promote digital adoption. To encourage digital competency in rural communities, it is important to implement support strategies through community stakeholders and other resources.