Abstract：
BACKGROUND: Telehealth technologies offer efficient ways to deliver health-related social needs (HRSN) screening in cancer care, but these methods may not reach all populations. The authors examined patient characteristics associated with using an online patient portal (OPP) to complete HRSN screening as part of gynecologic cancer care.
METHODS: From June 2021 to June 2023, patients in a gynecologic oncology clinic completed validated HRSN screening questions either (1) using the OPP (independently before the visit) or (2) in person (verbally administered by clinic staff). The authors examined the prevalence of HRSN according to activated OPP status and, in a restricted subgroup, used stepwise multivariate Poisson regression to identify associations between patient and visit characteristics and using the OPP.
RESULTS: Of 1616 patients, 87.4% (n = 1413) had an activated OPP. Patients with inactive OPPs (vs. activated OPPs) more frequently reported two or more needs (10% vs 5%; p < .01). Of 986 patients in the restricted cohort, 52% used the OPP to complete screening. The final multivariable model indicated that patients were less likely to use the OPP if they were Black (vs. White; adjusted relative risk [aRR], 0.70; 95% confidence interval [CI], 0.59-0.83); not employed (vs. employed; aRR, 0.81; 95% CI, 0.68-0.97), or had low measures of OPP engagement (aRR, 0.80; 95% CI, 0.68-0.92). New versus established patients were 21% more likely to use the OPP (aRR, 1.21; 95% CI, 1.06-1.38).
CONCLUSIONS: Differential use of the OPP suggested that over-reliance on digital technologies could limit the ability to reach those populations that have social factors already associated with cancer outcome disparities. Cancer centers should consider using multiple delivery methods for HRSN screening to maximize reach to all populations.
METHODS: From June 2021 to June 2023, patients in a gynecologic oncology clinic completed validated HRSN screening questions either (1) using the OPP (independently before the visit) or (2) in person (verbally administered by clinic staff). The authors examined the prevalence of HRSN according to activated OPP status and, in a restricted subgroup, used stepwise multivariate Poisson regression to identify associations between patient and visit characteristics and using the OPP.
RESULTS: Of 1616 patients, 87.4% (n = 1413) had an activated OPP. Patients with inactive OPPs (vs. activated OPPs) more frequently reported two or more needs (10% vs 5%; p < .01). Of 986 patients in the restricted cohort, 52% used the OPP to complete screening. The final multivariable model indicated that patients were less likely to use the OPP if they were Black (vs. White; adjusted relative risk [aRR], 0.70; 95% confidence interval [CI], 0.59-0.83); not employed (vs. employed; aRR, 0.81; 95% CI, 0.68-0.97), or had low measures of OPP engagement (aRR, 0.80; 95% CI, 0.68-0.92). New versus established patients were 21% more likely to use the OPP (aRR, 1.21; 95% CI, 1.06-1.38).
CONCLUSIONS: Differential use of the OPP suggested that over-reliance on digital technologies could limit the ability to reach those populations that have social factors already associated with cancer outcome disparities. Cancer centers should consider using multiple delivery methods for HRSN screening to maximize reach to all populations.
摘要：
背景：远程医疗技术提供了在癌症护理中提供与健康相关的社会需求（HRSN）筛查的有效方法，但是这些方法可能无法覆盖所有人群。作者检查了与使用在线患者门户（OPP）完成HRSN筛查相关的患者特征，这是妇科癌症护理的一部分。
方法：从2021年6月至2023年6月，妇科肿瘤诊所的患者完成了经过验证的HRSN筛查问题（1）使用OPP（在访视前独立）或（2）亲自（由诊所工作人员口头管理）。作者根据激活的OPP状态检查了HRSN的患病率，在受限制的子组中，使用逐步多变量泊松回归确定患者和就诊特征之间的关联,并使用OPP.
结果：在1616例患者中，87.4%(n=1413)的OPP活化。非活动OPP患者(vs.激活的OPP)更频繁地报告两个或更多的需求(10%对5%；p<.01)。在限制队列的986名患者中，52%采用OPP完成筛选。最终的多变量模型表明，如果患者是黑人，则患者使用OPP的可能性较小(与白色；调整后的相对风险[ARR]，0.70；95%置信区间[CI]，0.59-0.83)；未受雇(与受雇；ARR，0.81；95%CI，0.68-0.97），或OPP参与度的衡量标准较低(ARR，0.80；95%CI，0.68-0.92）。新患者与已确诊患者使用OPP的可能性高21%(aRR，1.21；95%CI，1.06-1.38）。
结论：OPP的差异使用表明，对数字技术的过度依赖可能会限制那些已经具有与癌症结果差异相关的社会因素的人群的能力。癌症中心应考虑使用多种递送方法进行HRSN筛查，以最大限度地覆盖所有人群。
方法：从2021年6月至2023年6月，妇科肿瘤诊所的患者完成了经过验证的HRSN筛查问题（1）使用OPP（在访视前独立）或（2）亲自（由诊所工作人员口头管理）。作者根据激活的OPP状态检查了HRSN的患病率，在受限制的子组中，使用逐步多变量泊松回归确定患者和就诊特征之间的关联,并使用OPP.
结果：在1616例患者中，87.4%(n=1413)的OPP活化。非活动OPP患者(vs.激活的OPP)更频繁地报告两个或更多的需求(10%对5%；p<.01)。在限制队列的986名患者中，52%采用OPP完成筛选。最终的多变量模型表明，如果患者是黑人，则患者使用OPP的可能性较小(与白色；调整后的相对风险[ARR]，0.70；95%置信区间[CI]，0.59-0.83)；未受雇(与受雇；ARR，0.81；95%CI，0.68-0.97），或OPP参与度的衡量标准较低(ARR，0.80；95%CI，0.68-0.92）。新患者与已确诊患者使用OPP的可能性高21%(aRR，1.21；95%CI，1.06-1.38）。
结论：OPP的差异使用表明，对数字技术的过度依赖可能会限制那些已经具有与癌症结果差异相关的社会因素的人群的能力。癌症中心应考虑使用多种递送方法进行HRSN筛查，以最大限度地覆盖所有人群。
