UC Davis

Patient-Provider Communications and Mental Health among Cancer Survivors in the United States: Health Disparities during COVID Compared to Pre-COVID

AbstractBackground Patient-Provider Communications play important roles in cancer survivors’ self-care and mental health management. However, the use and associations of perceived patient-centeredness and online-based communications with mental health outcomes among cancer survivors during SARS/COVID-19 (COVID) have been understudied.

ObjectiveThis dissertation examines the prevalence of and associated factors with optimal patient-centered communications (PCC), online patient-provider communications (OPPC) use, and poor mental health among cancer survivors during COVID in comparison with pre-COVID and those without a history of cancer.

MethodsNationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) were used for three studies among cancer survivors (n=2,579) and individuals without a history of cancer (n=13,292) during COVID (HINTS 5 2020) vs. pre-COVID (HINTS 5 1-3, 2017-2019). To assess the prevalence of optimal PCC (always perceiving PCC), OPPC use (email/internet, tablet/smartphone, electronic health records (EHR) use to communicate with providers), and poor mental health (depression as a chronic condition or depressive/anxiety symptoms in the past 2 weeks), weighted descriptive analyses were conducted to obtain frequency (n) and weighted percentage (%) with standard errors (SE). To investigate the associations of sociodemographic and health status factors with optimal PCC, OPPC use, and poor mental health, multivariable-weighted logistic regression models were developed to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs).

ResultsDuring COVID vs. pre-COVID, the prevalence of optimal PCC was lower (OR=0.73, 95% CI 0.54-0.98), and OPPC use was higher (ORs=1.61-1.92 in email/internet, EHR) among cancer survivors. However, the prevalence of poor mental health did not change significantly among cancer survivors from pre-COVID to COVID. Cancer survivors who had no usual source of care, were the oldest (≥75 years), or had poor mental health were less likely to have both optimal PCC and OPPC use. Income, race/ethnicity, marital status, health insurance type, and general health status were found to be associated with either optimal PCC or OPPC use. The COVID pandemic and a history of cancer were not associated with mental health. When adjusted for PCC and OPPC with other sociodemographic and health status factors, individuals who had low income, had low education, had a poor general health condition, or who were younger, were females, were non-Hispanic Whites, were significantly more likely to have poor mental health.

Conclusions

Our findings could inform tailored interventions to prevent further inequities in this population. Raising awareness of PCC roles among healthcare providers and patients through early-stage clinician training or collaborating with patient advocate groups for patient education may improve perceived PCC. Efforts to increase the coverage of virtual visits, enhance eHealth literacy, or improve health technology access might help those with low OPPC use. Furthermore, partnering with public health programs to reach target populations and providing life skills-based training and support could also help people with poor mental health.