Evaluating portal-enabled elicitation of patients' health-related values in solid tumor oncology: A qualitative content analysis.

Abstract

Electronic patient portals are increasingly used to improve care and patient-clinician communication. Portal-elicited health-related values (HRVs) were evaluated as to whether they contain themes similar to those arising from nurse-led in-person discussions. HRV questionnaires, consisting of seven questions, were sent by portal to patients of five solid tumor clinics from July 2023 to August 2024. Applying a theoretical framework generated from prior analysis of in-person nurse-led discussions with patients about their HRVs, questionnaires were coded via thematic content analysis. A total of 1556 HRV questionnaires were sent to individual patients. Of 852 unique patients who returned questionnaires with response to at least one question, a random subset of 200 patients' responses (167 gastrointestinal cancers, 33 genitourinary cancers) were analyzed by an interdisciplinary team. Analysis identified five themes consistent with those previously identified from in-person discussions: cancer as threat/disruption; expression of personhood and desire to retain a sense of self; communication with loved ones and the medical team as a tool for maintaining individual agency; connection to others as core to social identity and a source of individual strength; and sources of meaning and fulfillment. Uniquely identified by our analysis of portal responses were elements of financial toxicity and spiritual and existential well-being. Elicitation of patient values through the electronic portal provides valuable insights into the HRV of patients with solid tumors. The electronic portal captures values comparable to those elicited in in-person discussions, supporting efforts to scale such initiatives while preserving the content of patients' reports as a basis for discussion of their HRVs with clinicians.