1Department of Surgery.
2Department of Medicine.
J Natl Compr Canc Netw. 2022 Jul;20(7):765-773.e4. doi: 10.6004/jnccn.2022.7015.
Screening for cancer-related psychosocial distress is an integral yet laborious component of quality oncologic care. Automated preappointment screening through online patient portals (Portal, MyChart) is efficient compared with paper-based screening, but unstudied. We hypothesized that patient access to and engagement with EHR-based screening would positively correlate with factors associated with digital literacy (eg, age, socioeconomic status).
Screening-eligible oncology patients seen at our Comprehensive Cancer Center from 2014 through 2019 were identified. Patients with active Portals were offered distress screening. Portal and screening participation were analyzed via multivariable logistic regression. Household income in US dollars and educational attainment were estimated utilizing zip code and census data.
Of 17,982 patients, 10,279 (57%) had active Portals and were offered distress screening. On multivariable analysis, older age (odds ratio [OR], 0.97/year; P<.001); male gender (OR, 0.89; P<.001); Black (OR, 0.47; P<.001), Hawaiian/Pacific Islander (OR, 1.54; P=.007), and Native American/Alaskan Native race (OR, 0.67; P=.04); Hispanic ethnicity (OR, 0.76; P<.001); and Medicare (OR, 0.59; P<.001), Veteran's Affairs/military (OR, 0.09; P<.01), Medicaid (OR, 0.34; P<.001), or no insurance coverage (OR, 0.57; P<.001) were independently associated with lower odds of being offered distress screening; increasing income (OR, 1.05/$10,000; P<.001) and educational attainment (OR, 1.03/percent likelihood of bachelor's degree or higher; P<.001) were independently associated with higher odds. In patients offered electronic screening, participation rate was 36.6% (n=3,758). Higher educational attainment (OR, 1.01; P=.03) was independently associated with participation, whereas Black race (OR, 0.58; P=.004), Hispanic ethnicity (OR, 0.68; P=.01), non-English primary language (OR, 0.67; P=.03), and Medicaid insurance (OR, 0.78; P<.001) were independently associated with nonparticipation.
Electronic portal-based screening for cancer-related psychosocial distress leads to underscreening of vulnerable populations. At institutions using electronic distress screening workflows, supplemental screening for patients unable or unwilling to engage with electronic screening is recommended to ensure efficient yet equal-opportunity distress screening.
癌症相关心理困扰的筛查是高质量肿瘤护理的一个组成部分，但也是一项费力的工作。通过在线患者门户（Portal、MyChart）进行的自动化预约前筛查与基于纸质的筛查相比效率更高，但尚未得到研究。我们假设患者访问和参与基于电子健康记录（EHR）的筛查与数字素养相关因素（例如年龄、社会经济地位）呈正相关。
从 2014 年至 2019 年在我们的综合癌症中心就诊的符合筛查条件的肿瘤患者被确定。为有活跃门户的患者提供心理困扰筛查。通过多变量逻辑回归分析门户和筛查参与情况。利用邮政编码和人口普查数据估计家庭收入（以美元计）和教育程度。
在 17982 名患者中，有 10279 名（57%）有活跃的门户并被提供了心理困扰筛查。多变量分析显示，年龄较大（优势比 [OR]，每年 0.97；P<.001）；男性（OR，0.89；P<.001）；黑人（OR，0.47；P<.001）、夏威夷/太平洋岛民（OR，1.54；P=.007）和美国原住民/阿拉斯加原住民（OR，0.67；P=.04）；西班牙裔（OR，0.76；P<.001）；医疗保险（OR，0.59；P<.001）、退伍军人事务/军队（OR，0.09；P<.01）、医疗补助（OR，0.34；P<.001）或无保险（OR，0.57；P<.001）与较低的接受心理困扰筛查的可能性独立相关；收入增加（OR，1.05/每 10,000 美元；P<.001）和教育程度提高（OR，1.03/获得学士学位或更高学位的可能性百分比；P<.001）与较高的接受电子筛查的可能性独立相关。在被提供电子筛查的患者中，参与率为 36.6%（n=3758）。较高的教育程度（OR，1.01；P=.03）与参与独立相关，而黑人（OR，0.58；P=.004）、西班牙裔（OR，0.68；P=.01）、非英语为主要语言（OR，0.67；P=.03）和医疗补助保险（OR，0.78；P<.001）与不参与独立相关。
基于电子门户的癌症相关心理困扰筛查导致弱势群体筛查不足。在使用电子困扰筛查工作流程的机构中，建议对无法或不愿参与电子筛查的患者进行补充筛查，以确保高效且公平的困扰筛查。
