Patient Portal Engagement in Oncology: Results From the NU IMPACT Study in a Large Health Care System.

PURPOSE: Electronic patient portals can promote patient-centered care, but determinants of engagement remain underexplored in oncology. This study examines sociodemographic and clinical factors associated with engagement with four portal features, including invitations to complete patient-reported outcome (PRO) measures before appointments. METHODS: Secondary analysis of the Northwestern University IMproving the Management of symPtoms during and following Cancer Treatment study, a stepped-wedge cluster randomized trial to promote symptom management using PROs in adult oncology care was performed. For each enrolled participant, we examined portal usage across 1 year. RESULTS: A total of 3,457 patients were enrolled between April 2020 and April 2023 from 30 Northwestern Medicine ambulatory oncology clinics. Patients were 65% female, 85% White, and 85% non-Hispanic/Latino, with a mean age of 60.8 years. Cancer diagnoses were 30% breast, 12% lymphoma, and all other types accounted for <10% of the sample. Patients accessed laboratory results most frequently (median 23 days in the year), followed by messaging (median 11 days) and physician notes (median 2 days). A total of 62.6% of patients completed at least one invited PRO. Controlling for sociodemographic factors, patient characteristics that were associated with greater engagement across three or more features included more oncology appointments, high health literacy, high anxiety, one or more severe physical symptoms, and high shared decision making with their health care team. Black race, Hispanic/Latino ethnicity, and Medicaid insurance were associated with lower portal engagement. Patients who used any other portal features were more likely to complete PROs. In contrast to other portal features, patients with at least one severe physical symptom were less likely to complete PROs (incidence rate ratio, 0.87 [95% CI, 0.81 to 0.93]; P < .001). CONCLUSION: Portal use among patients with cancer varies by sociodemographic and clinical characteristics. Findings suggest a need for targeted interventions to promote equitable use among under-represented groups and promote portal-based PRO completion for patients with higher symptom burden.