JMIR Publications

ABSTRACT

Background:

Introduction: In the US, 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 when compared to their counterparts. For example, African-Americans have the highest mortality rates and shortest survival rates for most cancers when compared to other racial/ethnic groups in the US. A wide range of technologies (e.g., Internet-based [eHealth] technologies, mobile [mHealth] applications, and telemedicine) are available to patients that 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; yet, little is known of their use among underserved populations.

Objective:

The purpose of this article is to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations.

Methods:

Computer-based searches were conducted in the following academic databases: 1) PubMed [cancer subset]; 2) MEDLINE, 3) PsycINFO; and 4) CINAHL. We included articles that were reviewed, published in the English language, and conducted in the US. 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 articles for assessment of inclusion criteria. We systematically extracted information from each article meeting our inclusion criteria.

Results:

This review includes 71 articles that use patient-centered technologies which 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 non-adherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via text; however, challenges were experienced with respect to a lack of knowledge of how to text among some participants. More complex mobile technologies (e.g., a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, e.g., participants expressed concerns regarding security and unfamiliarity with the technology, and preferred further instruction and assistance in its use.

Conclusions:

There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and their receptivity among disparate populations, challenges still exist with respect to their effective use and usability.