Portal-enabled elicitation of patients’ health-related values (HRV) in solid tumor oncology: A qualitative analysis.

Abstract

573 Background: The electronic patient portal is increasingly used to provide more efficient care and improve patient-clinician communication. We previously demonstrated acceptability and higher patient ratings of clinician communication quality with nurse-led in-person discussions with oncology patients about their health-related values (HRV). The purpose of this study was to evaluate transferability of the framework from the in-person to portal-enabled context as a foundation for scaling high-quality person-centered communication and oncologic care. Methods: HRV questionnaires, each consisting of 7 questions as previously described in Epstein et al. 2025 ( JCO Oncol Pract DOI:10.1200/OP-25-00059), were sent by the Epic-based patient portal to individual patients of 5 oncology clinics: 4 gastrointestinal (GI) and 1 genitourinary (GU) from July 2023 to August 2024. Thematic content analysis was applied to identify key domains, categorize codes, and identify congruence and divergence of thematic constructs, as compared to the previously developed theoretical framework of patients’ navigation of a cancer diagnosis through in-person nurse-led discussion of values. Results: 1,556 HRV questionnaires were sent to individual patients as detailed above. Of 852 unique patients who returned questionnaires with response to at least one question, a random subset of 200 patient responses (23% of all patients who responded) were analyzed by an interdisciplinary team. Analysis of responses included 167 patients with GI cancers and 33 patients with GU cancers. Analysis identified five themes, which were 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. Conclusions: Elicitation of patient values through the electronic portal provided valuable insights to HRV of patients with solid tumor diagnoses. Compared to in-person discussions, the electronic portal appears to be an efficient method for eliciting HRVs, supporting efforts to scale such initiatives while preserving the content of patients’ reports as a basis for discussion of their HRVs with clinicians. Ongoing research investigates the optimal clinical implementation of portal-enabled HRV elicitation and effects on patient-centered oncologic care.

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