April 22-24, 2021
Promoting Equity in Health Communication Research
Promoting Equity in Health Communication Research
Abstract: A Content Analysis of Secure Messaging Between Patients with Cancer and Providers during COVID-19
Background
Patients with cancer and those who receive cancer treatment are often immunocompromised, meaning their immune system is weakened, raising their risk of getting severely sick from COVID-19. The danger of contracting SARS-CoV-2 has caused patients with cancer to be unsure about how to proceed with their cancer care. Alternative methods of communication, such as secure messaging, enable patients to continue correspondence with their oncology team and can serve as a proxy for in-person appointments. Secure messaging is a feature within electronic health records that allows for messages to be asynchronously exchanged between patients and providers. Research has shown that secure messaging supports a continuous patient-provider relationship and facilitates the transmission of additional advice and education. As we expected that more patients and providers rely on secure messaging during the pandemic, the purpose of this study was to categorize the topics and content of conversations.
Methods
Upon receiving IRB approval, de-identified messages between February – May 2020 were extracted from the electronic health record system. Messages were from patients with cancer at least 18 years old, and oncological providers. The individual messages were grouped in the sequence in which they were sent, comprising the entire conversation, which served as the unit of analysis. The research team initially read a sub-set of conversations and performed open coding to develop a preliminary codebook. To refine the codebook, 50 conversations were randomly selected and coded, resulting in 16 unique codes. Next, two rounds of interrater reliability occurred in which 10% (n=154) of the sample were coded. Coders achieved very high levels of agreement in both rounds (Kappa’s ranged from 0.742 – 1.0 for each variable). Two coders then independently coded the remaining conversations.
Results
A total of 1,454 conversations were analyzed, but only 26% (n=373) related to COVID-19. Among COVID-19 conversations, patients sending/receiving messages were mostly female (81%), white (78%), with a mean age of 55. Providers were physician assistants (41%), followed by physicians (23%) and nurses (11%). Patients were slightly more likely to initiate the correspondence (53%) than providers (47%). The most frequent category was “changes, adjustments, and re-arranging care” (65%), which consisted of messages related to altering treatment and facilitating care at an alternative site. Automated messages accounted for 36% of the total, primarily sent by physician assistants (93%), which alerted patients about new protocols at the hospital. The “risk for COVID-19” category (24%) included communication about whether a patient may be at higher risk for acquiring the virus due to issues such as compromised immunity. Interestingly, 18% of messages included encouraging and reassuring language, while only 7% pertained to questions about symptoms and testing.
Conclusion
As secure messaging is increasingly relied upon during the pandemic, our study found that secure messaging is mainly being used for changes in care. Specifically, messages served to arrange alternative care and convey information about new procedures in the hospital. Knowing the type of information being communicated during the pandemic can facilitate the creation of standardized messages to ease provider burden and preemptively answer patients’ questions.
Patients with cancer and those who receive cancer treatment are often immunocompromised, meaning their immune system is weakened, raising their risk of getting severely sick from COVID-19. The danger of contracting SARS-CoV-2 has caused patients with cancer to be unsure about how to proceed with their cancer care. Alternative methods of communication, such as secure messaging, enable patients to continue correspondence with their oncology team and can serve as a proxy for in-person appointments. Secure messaging is a feature within electronic health records that allows for messages to be asynchronously exchanged between patients and providers. Research has shown that secure messaging supports a continuous patient-provider relationship and facilitates the transmission of additional advice and education. As we expected that more patients and providers rely on secure messaging during the pandemic, the purpose of this study was to categorize the topics and content of conversations.
Methods
Upon receiving IRB approval, de-identified messages between February – May 2020 were extracted from the electronic health record system. Messages were from patients with cancer at least 18 years old, and oncological providers. The individual messages were grouped in the sequence in which they were sent, comprising the entire conversation, which served as the unit of analysis. The research team initially read a sub-set of conversations and performed open coding to develop a preliminary codebook. To refine the codebook, 50 conversations were randomly selected and coded, resulting in 16 unique codes. Next, two rounds of interrater reliability occurred in which 10% (n=154) of the sample were coded. Coders achieved very high levels of agreement in both rounds (Kappa’s ranged from 0.742 – 1.0 for each variable). Two coders then independently coded the remaining conversations.
Results
A total of 1,454 conversations were analyzed, but only 26% (n=373) related to COVID-19. Among COVID-19 conversations, patients sending/receiving messages were mostly female (81%), white (78%), with a mean age of 55. Providers were physician assistants (41%), followed by physicians (23%) and nurses (11%). Patients were slightly more likely to initiate the correspondence (53%) than providers (47%). The most frequent category was “changes, adjustments, and re-arranging care” (65%), which consisted of messages related to altering treatment and facilitating care at an alternative site. Automated messages accounted for 36% of the total, primarily sent by physician assistants (93%), which alerted patients about new protocols at the hospital. The “risk for COVID-19” category (24%) included communication about whether a patient may be at higher risk for acquiring the virus due to issues such as compromised immunity. Interestingly, 18% of messages included encouraging and reassuring language, while only 7% pertained to questions about symptoms and testing.
Conclusion
As secure messaging is increasingly relied upon during the pandemic, our study found that secure messaging is mainly being used for changes in care. Specifically, messages served to arrange alternative care and convey information about new procedures in the hospital. Knowing the type of information being communicated during the pandemic can facilitate the creation of standardized messages to ease provider burden and preemptively answer patients’ questions.