Bridging the digital divide for outpatients treated with anticancer chemotherapy: a retrospective quantitative and qualitative analysis of an adapted electronic Patient Reported Outcome program.

Purpose: Using electronic patient-reported outcomes (ePRO) in clinical trial has shown benefits for patients. However, the digital divide can lead to unequal access to telehealth. We investigated whether a dedicated support program could bridge that divide.

Methods: Between February 2021 and June 2022, outpatients undergoing chemotherapy for cancer at our teaching hospital in France were given the Onco'nect® ePRO application if they were affected by the digital divide. They were also offered a dedicated support program that included the lending of a tablet, access to healthcare professionals, training, technical support, and peer-to-peer guidance. We conducted semi-structured interviews to assess the challenges they faced.

Results: We enrolled 22 patients, of whom 10 (45%) made good use of the application and completed > 50% of the questionnaires in the application, while 5 (23%) completed > 75%. However, 12 (55%) of the 22 patients remained poor users of the application over a median participation of 4 months (IQR, 3-7). We also measured social deprivation but found no association with questionnaire completion rate. The under-use of Onco'nect® was due not only to the patients' understanding of its clinical benefit or to their computer skills, but also to poor health literacy and strong emotional responses to using the application.

Conclusion: Dedicated support programs help many patients make the most of telehealth. However, most of our patients in the digital divide under-used the ePRO application, primarily due to their poor health literacy.