Table 1.

Studies of web portal use by cancer patients.

Study	Sample	Design	Outcomes	Results
Pai et al. 2013	22 prostate cancer patients who received access to a web-based personal health record (PHR)	End-of-study survey	Usability, satisfaction, and concerns with provider	Of the 17 patients who completed the study, 29% encountered minor difficulties with the (PHR). The two most commonly accessed med- ical records were laboratory test results and transcribed doctor’s notes. 94% were satisfied with the access to their medical records, 65%
Gerber et al. 2014	6,495 patients at a cancer center who en- rolled in a web portal	Retrospective cohort	Increased portal use and portal functions used	From 2007 to 2012, the median number of portal log-ins was 57. The most common portal actions were viewing test results (37%), viewing and responding to clinic messages (29%0, and sending medical advice requests (6.4%). Increased portal use was significantly associated with younger age, white race, and an upper aerodigestive cancer diagnosis. Over the study period, the average number of pa- tient log-ins per year more than doubled.
Girault et al. 2015	1,371 outpatients (median age 53.4 years) at a compre- hen-sive cancer center	Questionnaire-based survey	Internet-based technologies (patient portals, websites and applications) usage and attitudes	Age and socioeconomic status were negative- ly associated with the use of internet-based technologies (<0.001). Regarding patients’ ex- pected benefits, a wide majority valued its use in health care, especially as a way to enhance communication with providers.
Kuijpers et al. 2015	23 cancer survivors	In-person interviews to evaluate content and graphic design of an interactive web portal for breast and lung cancer survivors, and usability testing of a prototype among 7 cancer survivors.	Content analysis was used to analyze the data of both the in- terviews and usability tests	Based on the first draft, survivors selected the preferred graphic design, approved the features and provided suggestions for the content. Usability testing revealed that it was relatively easy to navigate the website and use the different features.
Kuijpers et al. 2015	21 breast cancer sur- vivors, 14 lung cancer survivors, and 31 health profession-als	Five focus groups with cancer survivors and four focus groups with health professionals, to obtain input about possible features of an interactive web portal	Data were analyzed using content analysis	Important themes included fulfillment of in- formation needs, communication, motivation, quality of feedback, and supervision. Cancer survivors were primarily interested in features that could fulfill their information needs, i.e., survivorship care plan, access to their electronic medical record, and an overview of appointments. Health professionals considered patient reported outcomes and telemonitoring as the most useful features.
Kuijpers et al. 2016	92 breast cancer sur- vivors (mean age 49.5 years)	Four month trial of an interactive web portal	Website user satisfac- tion, patient activation score, quality of life (SF-36), and vigorous physical activity	Overview of appointments and access to the electronic medical record were most fre- quently used features and most highly valued. Average website user satisfaction was 3.8 on a 5-point scale. Patient activation scores did not change significantly. Three domains of the SF-36 (role functioning – emotional, mental health, and social functioning) and median vigorous physical activity improved significant- ly over time.
Laccetti et al. 2016	289 cancer center providers and clinic staff who performed patient portal activ- ities	Retrospective cohort	Total web portal actions and messages received	From 2009 to 2014, 289 employees per- formed 740,613 patient web portal actions and received 117,799 messages. Seventy-sev- en percent of actions were performed by nurses, 11% by ancillary staff, 6% by midlevel providers, and 5% by physicians. On average, 6.3 staff web portal actions were performed per patient-initiated message.
Groen et al. 2017	37 lung cancer pa- tients (mean age 59.6 years)	Questionnaires, a focus group, and analysis of interactive patient portal log data	Quality of life (SF-36) and patient activation score, and physical activity	The majority of responses (82%) about using the interactive patient portal were positive; 69% saw it as a valuable addition to care, and 56% perceived increased control over their health. No significant changes were observed in the outcome measures.
Alpert et al. 2018	35 cancer patients and 13 oncologists	In-depth, semi-struc- tured interviews aimed at better understanding communicative behav- iors and perceptions of a patient web portal and how it is utilized in oncology	Thematic analysis was used to examine the responses	Portals help to enhance participation during in-person consultations, increase patients’ self-advocacy, and build rapport with provid- ers. Patients’ level of comfort with reviewing information via the portal depended upon the severity of the test. Oncologists worried about patient anxiety and widening health dispar- ities, but noted that the portal can motivate them to expedite communication about test results.
Schultz & Alderfer, 2018	19 caregivers of chil- dren with cancer	One-on-one semi-struc- tured interviews	Inductive qualitative content analysis	Caregivers recognized advantages of portal use including getting results “fast,” being able to visualize trends in results, “keeping a record,” and not interfering with clinic flow. Perceived disadvantages included the results being “com- plicated” or easily misunderstood, and learning results prior to disclosure by care team.