Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient

Background and Significance

Patient portals allow patients to track test results, report self-administered medications, and communicate with their providers through portal-mediated secure messages (PSMs).[1] Oncology patients rate this opportunity to engage with their care team as more important than other patients, likely related to the increased complexity of their management.[2] PSMs provide a valuable source of information about patients, including references to health needs, care coordination, and questions about their treatment plans.[3] [4]

Some patients prefer that their caregivers have access to their patient portal to help coordinate care and overcome barriers such as geographic distance.[5] This has led to the development of registered proxy accounts or the setup of separate, distinct accounts for caregivers.[6] [7] However, an estimated less than 1% of caregivers utilize formal proxy accounts because it is more convenient for them to use the patient's account.[5] As such, PSMs are frequently not authored by the patient, requiring careful interpretation of the messages by the care team.[5] [8] A study found that 46% of adult diabetic patients had at least one PSM authored by a caregiver who used the patient's portal credentials to log in (unregistered proxy) instead of using their proxy account.[9] Identification of unregistered proxy users can enhance patient security through accurate authentication, ensure that needs expressed in PSMs are appropriately being responded to whether from patients or caregivers, and help systems leverage technology to address barriers to portal engagement.

Little is known about the prevalence of unregistered proxy use among oncology patients or the demographics of oncology patients that may have others send PSMs on their behalf. This study aimed to determine if sociodemographic differences exist between patients with a high number of presumed-unregistered proxy messages compared with those with few to no unregistered messages in our patient population.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Memorial Sloan Kettering Cancer Center Institutional Review Board.

Publication History

Received: 30 December 2022

Accepted: 16 January 2023

Accepted Manuscript online:
19 January 2023

Article published online:
19 April 2023

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