Oncology Clinicians Weigh Benefits, Challenges to Adolescents’ Patient Portal Access 

Oncology clinicians reported improved communications with adolescent patients as one of several benefits to using patient portals. However, they also identified mixed levels of patient engagement and confidentiality as challenges to using this technology. These study findings were reported in the journal JCO Clinical Cancer Informatics.

The study was based on semistructured interviews of oncology clinicians across 26 institutions in 16 US states. Participants were physicians or advanced practice providers (APPs) providing care for adolescents with cancer. The study investigators evaluated the interviews to identify themes in participants’ responses and to assess benefits, problems, and accommodations participants use in regard to the use of patient portals.

A total of 29 physicians and 24 APPs participated in this study. Among the physicians, 93% reported that adolescents were able to access their patient portal; among the APPs, 75% reported adolescents’ ability to access their patient portal. Parents were able to access adolescents’ patient portal according to 100% of physicians and 88% of APPs. 

Key themes identified in participant interviews regarding patient portals included empowering adolescents, improving efficiency and accuracy of communication, promoting open and adaptive communication, supporting parents in management of care, and strengthening clinical relationships.

Portal access appeared to empower adolescents toward becoming more involved in their care. For example, adolescent patients could use the portal to ask questions they did not wish to ask in front of their parents. Communication was improved, as patients could review results in the portal without needing to call the clinic. Asynchronous messaging also enabled more convenience in communication.

Although portal access was empowering to adolescents, parental access to the portal was also useful in managing care, as some adolescents appeared to rely on parental assistance during cancer treatment. Portal access also promoted trust in the clinical team, since the interface enhanced transparency. 

However, 8 themes related to problems caused by access to the patient portal were identified, including emotional distress and confusion, increases in workload and changes to workflow among clinic staff, potential threats to adolescent confidentiality, a lack of interest in engagement by adolescents, potential for information viewable in the portal to diminish the clinical relationship, misuse of portal messaging, potential for diminished quality of sensitive documentation, and difficulties for adolescents if parents would lose access to the portal. 

Accommodations made by participants due to portal access included modifications to note writing, providing anticipatory guidance on viewing results in the portal, and adaptations to workflows. 

“To make portals useful, we must take steps to mitigate risks while preserving functionality. These solutions will require technological advancement, ethical and policy problem-solving, and further research on parental and adolescent experiences with portal use,” the study investigators wrote in their report. 

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Sisk BA, Bereitschaft C, Enloe M, Schulz G, Mack J, DuBois J. Oncology clinicians’ perspectives on online patient portal use in pediatric and adolescent cancer. JCO Clin Cancer Inform. 2023;7:e2300124. doi:10.1200/CCI.23.00124