Identification of Barriers to Digital Patient Portal Adoption Among Patients With Prostate Cancer Undergoing Curative Radiotherapy at a Canadian Provincial Cancer Program: A Quality Improvement Study

PURPOSE Digital patient portals (DPPs) provide patients a direct electronic link with their care teams allowing secure, rapid symptom reporting and the capture of electronic patient-reported outcome questionnaires. A proportion of patients face barriers to DPP adoption. We conducted a prospective observational cohort study to quantify the proportion of DPP nonadopters and identify factors associated with DPP nonadoption. METHODS All patients with prostate cancer undergoing radical radiotherapy at a Canadian Provincial Cancer Program were given the opportunity to install a DPP on their mobile device/tablet before starting radiotherapy. Each patient completed a self-reported questionnaire assessing their willingness and ability to use the DPP and quantified variables associated with their decision. A DPP adopter was defined as a patient who logged into the application and accessed their radiotherapy educational materials. Descriptive variables were tabulated by DPP adoption status. Differences in distributions of baseline characteristics were assessed using standard parametric and nonparametric statistics. Univariable and multivariable logistic regression analyses were performed to identify variables associated with DPP nonadoption. RESULTS Between July 2022 and January 2023, 118 patients with prostate cancer were enrolled with a median age of 71 years (range, 50-86). Most patients (56.8%) had a college diploma, 29.6% lived rurally, and 95.8% owned a smartphone. Twenty-eight patients (23.8%) were DPP nonadopters. On stepwise multivariable logistic regression analysis, poor self-reported ability to use mobile devices was associated with DPP nonadoption ( P < .01). CONCLUSION Among patients with prostate cancer undergoing radical radiotherapy, poor self-reported ability to use smartphone technology was identified as the primary barrier to DPP adoption. Interventions geared at mitigating this barrier to DPP adoption are needed.