Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting
Abstract Purpose Prior studies suggest email communication between patients and providers may improve patient engagement and health outcomes. The purpose of this study was to determine whether patient‐initiated emails are associated with overall survival benefits among cancer patients undergoing che...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-11-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.3483 |
| _version_ | 1818302337283784704 |
|---|---|
| author | Jean Coquet Douglas W. Blayney James D. Brooks Tina Hernandez‐Boussard |
| author_facet | Jean Coquet Douglas W. Blayney James D. Brooks Tina Hernandez‐Boussard |
| author_sort | Jean Coquet |
| collection | DOAJ |
| description | Abstract Purpose Prior studies suggest email communication between patients and providers may improve patient engagement and health outcomes. The purpose of this study was to determine whether patient‐initiated emails are associated with overall survival benefits among cancer patients undergoing chemotherapy. Patients and methods We identified patient‐initiated emails through the patient portal in electronic health records (EHR) among 9900 cancer patients receiving chemotherapy between 2013 and 2018. Email users were defined as patients who sent at least one email 12 months before to 2 months after chemotherapy started. A propensity score‐matched cohort analysis was carried out to reduce bias due to confounding (age, primary cancer type, gender, insurance payor, ethnicity, race, stage, income, Charlson score, county of residence). The cohort included 3223 email users and 3223 non‐email users. The primary outcome was overall 2‐year survival stratified by email use. Secondary outcomes included number of face‐to‐face visits, prescriptions, and telephone calls. The healthcare teams’ response to emails and other forms of communication was also investigated. Finally, a quality measure related to chemotherapy‐related inpatient and emergency department visits was evaluated. Results Overall 2‐year survival was higher in patients who were email users, with an adjusted hazard ratio of 0.80 (95 CI 0.72–0.90; p < 0.001). Email users had higher rates of healthcare utilization, including face‐to‐face visits (63 vs. 50; p < 0.001), drug prescriptions (28 vs. 21; p < 0.001), and phone calls (18 vs. 16; p < 0.001). Clinical quality outcome measure of inpatient use was better among email users (p = 0.015). Conclusion Patient‐initiated emails are associated with a survival benefit among cancer patients receiving chemotherapy and may be a proxy for patient engagement. As value‐based payment models emphasize incorporating the patients’ voice into their care, email communications could serve as a novel source of patient‐generated data. |
| first_indexed | 2024-12-13T05:37:18Z |
| format | Article |
| id | doaj.art-991c5d001620466e88e379bd41235d03 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-13T05:37:18Z |
| publishDate | 2020-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-991c5d001620466e88e379bd41235d032022-12-21T23:57:53ZengWileyCancer Medicine2045-76342020-11-019228552856110.1002/cam4.3483Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world settingJean Coquet0Douglas W. Blayney1James D. Brooks2Tina Hernandez‐Boussard3Department of Medicine Stanford University Stanford CA USADepartment of Medicine Stanford University Stanford CA USADepartment of Urology Stanford University School of Medicine Stanford CA USADepartment of Medicine Stanford University Stanford CA USAAbstract Purpose Prior studies suggest email communication between patients and providers may improve patient engagement and health outcomes. The purpose of this study was to determine whether patient‐initiated emails are associated with overall survival benefits among cancer patients undergoing chemotherapy. Patients and methods We identified patient‐initiated emails through the patient portal in electronic health records (EHR) among 9900 cancer patients receiving chemotherapy between 2013 and 2018. Email users were defined as patients who sent at least one email 12 months before to 2 months after chemotherapy started. A propensity score‐matched cohort analysis was carried out to reduce bias due to confounding (age, primary cancer type, gender, insurance payor, ethnicity, race, stage, income, Charlson score, county of residence). The cohort included 3223 email users and 3223 non‐email users. The primary outcome was overall 2‐year survival stratified by email use. Secondary outcomes included number of face‐to‐face visits, prescriptions, and telephone calls. The healthcare teams’ response to emails and other forms of communication was also investigated. Finally, a quality measure related to chemotherapy‐related inpatient and emergency department visits was evaluated. Results Overall 2‐year survival was higher in patients who were email users, with an adjusted hazard ratio of 0.80 (95 CI 0.72–0.90; p < 0.001). Email users had higher rates of healthcare utilization, including face‐to‐face visits (63 vs. 50; p < 0.001), drug prescriptions (28 vs. 21; p < 0.001), and phone calls (18 vs. 16; p < 0.001). Clinical quality outcome measure of inpatient use was better among email users (p = 0.015). Conclusion Patient‐initiated emails are associated with a survival benefit among cancer patients receiving chemotherapy and may be a proxy for patient engagement. As value‐based payment models emphasize incorporating the patients’ voice into their care, email communications could serve as a novel source of patient‐generated data.https://doi.org/10.1002/cam4.3483chemotherapycommunicationemailsurvival |
| spellingShingle | Jean Coquet Douglas W. Blayney James D. Brooks Tina Hernandez‐Boussard Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting Cancer Medicine chemotherapy communication survival |
| title | Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting |
| title_full | Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting |
| title_fullStr | Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting |
| title_full_unstemmed | Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting |
| title_short | Association between patient‐initiated emails and overall 2‐year survival in cancer patients undergoing chemotherapy: Evidence from the real‐world setting |
| title_sort | association between patient initiated emails and overall 2 year survival in cancer patients undergoing chemotherapy evidence from the real world setting |
| topic | chemotherapy communication survival |
| url | https://doi.org/10.1002/cam4.3483 |
| work_keys_str_mv | AT jeancoquet associationbetweenpatientinitiatedemailsandoverall2yearsurvivalincancerpatientsundergoingchemotherapyevidencefromtherealworldsetting AT douglaswblayney associationbetweenpatientinitiatedemailsandoverall2yearsurvivalincancerpatientsundergoingchemotherapyevidencefromtherealworldsetting AT jamesdbrooks associationbetweenpatientinitiatedemailsandoverall2yearsurvivalincancerpatientsundergoingchemotherapyevidencefromtherealworldsetting AT tinahernandezboussard associationbetweenpatientinitiatedemailsandoverall2yearsurvivalincancerpatientsundergoingchemotherapyevidencefromtherealworldsetting |