Electronic Health Information Exchange Opportunities for Self-management of Care: Responses from Older Adults With and Without Cancer History in the United States

  • Shirley M. Bluethmann
  • Kisha I. Coa
  • Catherine M. Alfano
  • Bradford W. Hesse
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Purpose of Study

Of 15.5 million US cancer survivors, 80% are ≥ 55 years. Supporting older patients in care self-management through electronic health information (EHI) exchange may enhance recovery. We assessed: (1) perceived importance of EHI access to adults ≥ 55 years (incl survivors) and (2) age-related preferences for EHI exchange.

Recent Findings

Older adults are one of the fastest-growing user groups for internet/technologies. Most older adults 55–64 years are active internet users, and use among adults ≥ 65 years is growing quickly as baby boomers mature. Understanding EHI patient-provider exchange preferences may provide opportunities for older patients but also begin to address the future needs of other patient populations, including cancer survivors.


We observed a “digital divide” for perceived importance of EHI access and EHI exchange interests. Engaging older adults (i.e., ≥ 75 years) to improve comfort/experience with technologies may support EHI use in self-management. Survivors may have distinct EHI needs/preferences than older adults without cancer history.


Cancer informatics Self-management Health information technology Healthy aging 


Funding Information

This project has been funded in whole or in part with federal funds from the National Cancer Institute, part of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

Shirley M. Bluethmann, Kisha I. Coa, Catherine M. Alfano, and Bradford W. Hesse declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. Scholar
  2. 2.
    Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomark Prev. 2011;20(10):1996–2005. Scholar
  3. 3.
    Rowland JH, Bellizzi KM. Cancer survivorship issues: life after treatment and implications for an aging population. J Clin Oncol. 2014;32(24):2662–8. Scholar
  4. 4.
    •• Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25:1029–36. According to this report from the NCI Office of Cancer Survivorship, the prevalent population is projected to grow to 26.1 million by 2040, and will include 73% of survivors who are 65 years and older. Comorbidity burden was highest in the oldest survivors (those ≥ 85 years) and worst among lung cancer survivors. CrossRefGoogle Scholar
  5. 5.
    Risendal BC, Dwyer A, Seidel RW, et al, Meeting the challenge of cancer survivorship in public health: results from the evaluation of the chronic disease self-management program for cancer survivors. Evidence-Based Programming for Older Adults:172, 2015.Google Scholar
  6. 6.
    Hausman J, Ganz PA, Sellers TP, Rosenquist J. Journey forward: the new face of cancer survivorship care. Am J Manag Care. 2011;17:e187–93.PubMedGoogle Scholar
  7. 7.
    Clauser SB, Wagner EH, Aiello Bowles EJ, Tuzzio L, Greene SM. Improving modern cancer care through information technology. Am J Prev Med. 2011;40(5):S198–207. Scholar
  8. 8.
    Emery EE, Lapidos S, Eisenstein AR, Ivan II, Golden RL. The BRIGHTEN program: implementation and evaluation of a program to bridge resources of an interdisciplinary geriatric health team via electronic networking. The Gerontologist. 2012;52(6):857–65. Scholar
  9. 9.
    Kiel JM. The digital divide: Internet and e-mail use by the elderly. Inform Health Soc Care. 2005;30:19–23.Google Scholar
  10. 10.
    Choi NG, Dinitto DM. The digital divide among low-income homebound older adults: Internet use patterns, ehealth literacy, and attitudes toward computer/internet use. J Med Internet Res. 2013;15(5):e93. Scholar
  11. 11.
    Kontos E, Blake KD, Chou WS, et al. Predictors of eHealth usage: insights on the digital divide from the health information national trends survey 2012. J Med Internet Res. 2014;16(7):e172. Scholar
  12. 12.
    Chesser A, Burke A, Reyes J, et al. Navigating the digital divide: a systematic review of eHealth literacy in underserved populations in the United States. Inform Health Soc Care. 2015;41:1–19.CrossRefPubMedGoogle Scholar
  13. 13.
    Charness N, Boot WR. Aging and information technology use: potential and barriers. Curr Dir Psychol Sci. 2009;18(5):253–8. Scholar
  14. 14.
    Zickuhr K, Madden M. Older adults and internet use. Pew Internet & American Life Project 6, 2012.Google Scholar
  15. 15.
    de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, et al. Cancer survivors in the united states: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev. 2013;22(4):561–70. Scholar
  16. 16.
    Beckjord EB, Arora NK, McLaughlin W, Oakley-Girvan I, Hamilton AS, Hesse BW. Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care. J Cancer Surviv. 2008;2(3):179–89. Scholar
  17. 17.
    Beckjord EB, Rechis R, Nutt S, Shulman L, Hesse BW. What do people affected by cancer think about electronic health information exchange? Results from the 2010 LIVESTRONG electronic health information exchange survey and the 2008 health information national trends survey. Journal of Oncology Practice. 2011;7(4):237–41. Scholar
  18. 18.
    Rutten LJF, Vieux SN, St Sauver JL, et al. Patient perceptions of electronic medical records use and ratings of care quality. Patient Relat Outcome Meas. 2014;5:17.CrossRefGoogle Scholar
  19. 19.
    Zulman DM, Jenchura EC, Cohen DM, Lewis ET, Houston TK, Asch SM. How can eHealth technology address challenges related to multimorbidity? Perspectives from patients with multiple chronic conditions. J Gen Intern Med. 2015;30(8):1063–70. Scholar
  20. 20.
    Stellefson M, Alber JM, Wang MQ, Eddy JM, Chaney BH, Chaney JD. Use of health information and communication technologies to promote health and manage behavioral risk factors associated with chronic disease: applications in the field of health education. Am J Health Educ. 2015;46(4):185–91. Scholar
  21. 21.
    Schulz R, Wahl H, Matthews JT, et al. Advancing the aging and technology agenda in gerontology. The Gerontologist, 2014.Google Scholar
  22. 22.
    Peek ST, Wouters EJ, van Hoof J, et al. Factors influencing acceptance of technology for aging in place: a systematic review. Int J Med Inf. 2014;83(4):235–48. Scholar
  23. 23.
    Massey PM. Where do US adults who do not use the internet get health information? Examining digital health information disparities from 2008 to 2013. J Health Commun. 2016;21(1):118–24. Scholar
  24. 24.
    Moser RP, Naveed S, Cantor D, et al. Integrative analytic methods using population-level cross-sectional data. HINTS data briefs. Washington, DC: US Department of Health and Human Services; 2013.Google Scholar
  25. 25.
    Finney Rutten LJ, Davis T, Beckjord EB, Blake K, Moser RP, Hesse BW. Picking up the pace: changes in method and frame for the health information national trends survey (2011–2014). J Health Commun. 2012;17(8):979–89. Scholar
  26. 26.
    • Serrano KJ, Yu M, Riley WT, et al. Willingness to exchange health information via mobile devices: findings from a population-based survey. Ann Fam Med. 2016;14:34–40. Respondents in this nationally representative survey were less willing via mobile devices to exchange information considered sensitive or complex. Age, socioeconomic factors, and trust in professional information were associated with willingness to engage in mobile health information exchange and should be considered when developing and tailoring mobile technologies for patient-clinician communication. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chen Y, Lee BD, Kirk RM. Internet use among older adults: constraints and opportunities, IGI Global, 2012.Google Scholar
  28. 28.
    Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, et al. Web 2.0 chronic disease self-management for older adults: a systematic review. J Med Internet Res. 2013;15(2):e35. Scholar
  29. 29.
    Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, et al. Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med. 2005;165(22):2618–24. Scholar
  30. 30.
    Arora NK, Hesse BW, Rimer BK, Viswanath K, Clayman ML, Croyle RT. Frustrated and confused: the American public rates its cancer-related information-seeking experiences. J Gen Intern Med. 2008;23(3):223–8. Scholar
  31. 31.
    Hesse BW, Arora NK, Burke Beckjord E, Finney Rutten LJ. Information support for cancer survivors. Cancer. 2008;112(S11):2529–40. Scholar
  32. 32.
    Blumenthal D. Launching HIteCH. N Engl J Med. 2010;362(5):382–5. Scholar
  33. 33.
    Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–4. Scholar
  34. 34.
    Miller LMS, Bell RA. Online health information seeking: the influence of age, information trustworthiness, and search challenges. J Aging Health. 2012;24(3):525–41. Scholar
  35. 35.
    • Hesse BW, Greenberg AJ, Rutten LJF. The role of internet resources in clinical oncology: promises and challenges. Nat Rev Clin Oncol. 2016;13(12):767–76. In this commentary, findings from the NCI's Health Information National Trends Survey are reviewed to highlight Internet trends related to oncology patients. Future trends are discussed, including examples of “connected health” in oncology and an evolution in how networks can support person-centered and family-centered care. CrossRefPubMedGoogle Scholar
  36. 36.
    Chou WS, Hunt YM, Beckjord EB, Moser RP, Hesse BW. Social media use in the united states: implications for health communication. J Med Internet Res. 2009;11(4):e48. Scholar
  37. 37.
    Lustria MLA, Smith SA, Hinnant CC. Exploring digital divides: an examination of eHealth technology use in health information seeking, communication and personal health information management in the USA. Health Informatics Journal. 2011;17(3):224–43. Scholar
  38. 38.
    Fox S, Duggan M. The diagnosis difference: a portrait of the 45% of US adults living with chronic health conditions. Washington, DC: Pew Internet & American Life Project; 2013.Google Scholar
  39. 39.
    •• American Society of Clinical Oncology. The state of cancer care in america, 2017: a report by the American Society Of Clinical Oncology. J Oncol Pract. 2017;13(4):e353–94. In this fourth annual State of Cancer Care in America report, ASCO describes the opportunities and challenges that confront the cancer care community. They highlight the need for rapid transformation in healthcare built on (1) new investments in science and insurance coverage, (2) new payment systems that emphasize quality, and (3) new data sources and health care systems. CrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Shirley M. Bluethmann
    • 1
    • 2
    • 3
  • Kisha I. Coa
    • 4
  • Catherine M. Alfano
    • 5
  • Bradford W. Hesse
    • 1
  1. 1.Public Health Sciences The Pennsylvania State University College of MedicineHersheyUSA
  2. 2.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  3. 3.Department of Public Health Sciences, College of MedicineThe Pennsylvania State UniversityHersheyUSA
  4. 4.ICF InternationalRockvilleUSA
  5. 5.SurvivorshipAmerican Cancer Society, Inc.WashingtonUSA

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