The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review

• Published in: Journal of medical Internet research 2019-04, Vol.21 (4), p.e10256-e10256
• Main Authors: Tarver, Will L, Haggstrom, David A
• Format: Article
• Language: English
• Subjects: African Americans; Cancer; Cancer patients; Comparative analysis; Diagnosis; Discrimination in medical care; Health aspects; Health care disparities; Humans; Mass Screening; Medically Underserved Area; Mortality; Neoplasms - epidemiology; Patient-Centered Care - trends; Review; Target marketing; Technology; Telemedicine - methods; United States; Vulnerable Populations - statistics & numerical data
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/10256

In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populati