Age-related trends in utilization of the internet and electronic communication devices for coordination of cancer care in elderly patients
Introduction
Communication with patients with cancer has unique characteristics that make it different from communication in other healthcare contexts. Patients with cancer diagnoses engage the healthcare system in several situations: screening, diagnosis, multi-modality therapy, post-cancer treatment, and survivorship programs. Care of patients with cancer requires a multidisciplinary approach, with different physicians and healthcare workers involved in the care of a single patient. This multidisciplinary approach is complex and requires effective communication between healthcare providers and the patient. Impaired communication may result in decreased quality of care.[1], [2]
Once a diagnosis of cancer is given, patient and the families are fraught with anxiety and hence there is potential for impaired understanding of the information communicated by care providers. Communication during outpatient visits has become one of the most important targets to improve quality of interactions with patients. The ability to coordinate the laboratory testing, imaging and different specialist appointments is vital to decrease patient's anxiety level and avoid treatment delay. As recognized by the Institute of Medicine (IOM) in their “Crossing the Quality of Chasm” report, exchange of information and facilitation of patient navigation and empowerment are two of the six key functions for optimal patient health communication and outcomes.3
In this new era of the internet, mobile devices, and web-based information, healthcare providers are seeking appropriate ways for incorporating new technologies for communication with patients with cancer. Seventy-five percent of adults in the U.S. used the internet in 2011, and 80% of them looked up health-related topics.4 Along with exponential growth in internet use, the utilization of smartphones and other mobile devices has increased. Forty-two percent of Americans owned a smartphone in 2009,5 representing one of the only segments of market growth during the 2008 economic recession. It is not clear if the adoption of these new technologies improves quality of communication in patients with cancer, particularly the elderly. The National Cancer Institute reported that almost 53% of all cancer diagnosis made in the U.S. are in patients older than age 65.6 In the United Kingdom 63% of cancer diagnoses are in patients older than 65 and more than 36% are in patients older than age 75.7 The Pew Internet & American Life Project reported that only 16% of people older than age 65 use wireless internet compared to 80% use in the 18 to 29 age group or 66% in the 30 to 49 age group.5 In the age group older than 65, access to internet is very limited with only 40% having access.8 Therefore, elderly patients with cancer may not benefit from the use of the internet, mobile devices, and web-based information for coordination of clinical care (CCC) or exchange of health-related information (HRI). More importantly, retention of more traditional methods of communication may be required to ensure the accessibility of HRI and effective CCC for elderly patients with cancer.
In this study we surveyed 126 patients with cancer at the Roger Williams Medical Center to evaluate age-related patterns in internet access and preferences for methods of outpatient communication and exchange of HRI. The objective was to define age groups that are less likely to benefit from electronic communication and thus require more traditional methods for transmission of HRI and CCC.
Section snippets
Materials and Methods
We collected data after Institutional Review Board (IRB) approval. Surveys were distributed during a period of 4 months at the Roger Williams Cancer Center outpatient clinic and were independently completed by patients with cancer prior to scheduled appointments (Table 1). Two groups were defined to detect age-related preferences of the younger (< age 65, group A) or elderly (≥ age 65, group B) patients with cancer. The age cutoff of 65 was chosen based upon the World Health Organization
Results
A total of 250 surveys were distributed with a 50% (126 surveys) response rate. From these 126 surveys, 70 (55%) were patients < 65 years old (group A) and 56 (44%) were ≥ 65 years of age (group B). The mean age was 62, while the youngest patient surveyed was 28 years old and the oldest was 93 years old. Sixty-nine (55%) were females and 57 (45%) were males.
When evaluating access to the internet, 77% of group A and only 36% in group B had access to the internet (p < 0.001). Seventy-one percent in group
Discussion
The use of internet and mobile devices has rapidly increased in the last few years. More adults have access to the internet and up to 42% of the adults in the U.S. use smartphones with internet access. Integration between new technologies and healthcare offers new ways to exchange health information and coordinate patient care. However, reluctance or inability of elderly patients with cancer to utilize new communication technologies needs to be identified to avoid hindering CCC and exchange of
Conclusion
The data supports that there is an age-defined gap in the access and use of internet and electronic devices to exchange HRI and CCC. Characterization of this age-dependent transition zone is important to target future strategies to improve delivery of HRI and CCC to the different age groups. This transition zone may be dynamic or remain constant depending on multiple factors, which are difficult to identify and evaluate. In either case healthcare providers will need to rapidly adapt, using the
Disclosures and Conflict of Interest Statements
The authors have no conflicts of interest to disclose.
Authorship Contributions
Study concept and design: P. Somasundar, S.C. Katz, A. Saied
Data acquisition: K.M. Perry, D.J. Castricone
Quality control of data and algorithms: D.J. Castricone, K.M. Perry
Data analysis and interpretation: A. Saied, S.J. Sherry, P. Somasundar
Statistical analysis: A. Saied
Manuscript preparation: A. Saied, S.C. Katz, P. Somasundar
Manuscript editing and review: S.C. Katz, P. Somasundar
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2019, Journal of Medical Imaging and Radiation SciencesCitation Excerpt :One study found that only 33% of patients with cancer over the age of 65 had access to the Internet, and only 40% felt comfortable using it [21]. Our patient population (mostly 61–70 years old) falls into what Saeid et al refer to as a “transition zone,” where preference for nonelectronic resources increases with age [21]. However, one participant indicated that an electronic document would allow them to click on hyperlinks, thus facilitating access to the online resources cited in the guidelines.
The “Smartstone”: using smartphones as a telehealth gateway for senior citizens
2016, IFAC-PapersOnLineThe Analysis of the Context of Digital Access to Healthcare in Russia
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