Real-World Patient Engagement Highlights Opportunities for Digital Care Integration

Digital health solutions have the potential to improve outcomes via remote symptom monitoring, increase patient/physician communication, and improve patient education. Engagement with these tools can also inform future directions in oncology development through the capture of real-world population data via patient-reported outcomes (PROs).

Age, language, and patient location have been identified as barriers to the seamless implementation to digital health solutions across community and academic settings. Investigators from Texas Oncology, with 220 across the state in both urban and rural communities, examined the use of digital health solutions in practice and observe unaddressed barriers and gaps in care.^1,2

“Enhancements to address these disparities are necessary to further our efforts to decrease digital divides and ensure access for all patients,” Debra A. Pratt, MD, PhD, MBA, lead study and executive vice president of Texas Oncology, wrote in a poster of the data. The poster was presented during the 2022 American Society of Clinical Oncology Annual Meeting.¹

Investigators used a digital health platform from Navigating Cancer, which captures electronic PROs using a remote symptom and oral adherence tracker and provides access to patient’s personal health information and health education materials (FIGURE).^1,3 Patients with cancer who were enrolled with a portfolio between March 1, 2019, and March 31, 2022, were included in the study. Those who used at least 1 of digital tools (PRO completion, patient portal login to access health records, or digital education materials) were considered part of the engaged population (n = 100,888).¹

Percentage of engagement and use was calculated for each component of the tool including the following:

1. PRO
   1. Engagement: patient completed at least 1 assessment

1. Use: completion rate defined as the total assessments completed out of the number of assessments sent

1. Patient portal
   1. Engagement: patient registered and had at least 1 portal login
   2. Use: average number of portal logins
2. Digital education
   1. Engagement: patient received at least 1 article
   2. Use: read rate defined as the total number of articles read out of the number of articles sent

Among the engaged population, 11,086 patients (11%) engaged in PRO, 69,954 (68.3%) engaged with the patient portal, and 16,050 (15.9%) engaged with the digital education materials. In terms of total digital interactions among this group (n = 1,163,705), 267,475 took place in PROs, 832,213 took place in the patient portal, and 64,017 took place in digital education. There was an average of 11.5 encounters per patient.¹

Investigators reported that digital activity rates within the Navigating Cancer platform were high with approximately 55% of patients complying with PRO, an average of 12.06 portal logins, and 66.7% article read rate. the digital read rate was 96% among patients read 1 article.

Of interest to investigators were age (< 65 years vs ≥ 65 years), language preference (English speaking vs Spanish speaking), and distance from the clinic (nonrural, ≤ 20 miles vs rural, ≤ 20 miles).

More than half of patients in the engaged cohort were aged 65 years or older (51.8%), English speaking (96.8%), and nonrural (70.6%). More patients under the age of 65 years (53.9%) and a higher percentage of patients in rural locations (31.8%) as well as Spanish speaking patients (3.9%) were included in the PROs subgroup compared with the overall population.¹

Engagement

Engagement rates for PRO and patient portal were significant (P < .01) for patients aged less than 65 years (PRO, 72.5%; patient portal, 84.1%) compared with those who were aged at least 65 years (PRO, 62.5%; patient portal, 82.2%). Further, English language patients were more engaged across the subgroups.¹

Participation rates of patients in rural and nonrural settings were in the subgroups. For PROs the engagement rates were 67% vs 69%, respectively, and were 87% and 57% for both groups in patient portal and digital education engagement, respectively.

Use

Interestingly, the completion rates for PROs were significantly higher (P < .001) among those aged 65 years or older (55.5% vs 53.6%) with no significant difference in the number of patient portal logins (average, 12.4 vs 11.6). Digital education read rates were comparable at 96.2% vs 96.6% among the age populations, respectively.¹

In terms of language, English speaking patients had a significantly higher use (P < .001) across subgroups in the digital health solutions compared with Spanish speaking patients. PRO completion rates were 54.4% vs 47.9%, respectively, and digital read rates were 96.5% vs 91.8%, respectively. The average patient portal logins were 12.07 vs 11.52, respectively.

In terms of location, rates varied across the subgroups for usage. For PROs, rural patients had a use rate of 53.2% compared with 55.4% for nonrural patients and the digital read rates were 96.2% vs 96.4%, respectively. The average patient portal logins were 12.8 vs 11.7, which was deemed significant by investigators (P < .001).

“Despite variable engagement based on these factors, patients within these population continue to utilize the digital health solution,” the study authors wrote. “Individual tool enhancement for language differences should be explored, as…tool optimization for patient-specific barriers to care [are considered].”

References

1. Patt DA, Patel AM, Hudson KE, et al. Analyzing patient engagement with digital health tools to facilitate equity across a large statewide community oncology practice. J Clin Oncol. 2022;40(suppl 16):1575. doi:10.1200/JCO.2022.40.16_suppl.1575
2. Who we are. Texas Oncology. Accessed July 7, 2022. bit.ly/3bL14pY
3. Providers. Navigating Cancer. Accessed July 7, 2022. bit.ly/3ReAeXD