A mixed-methods study characterizing patient experiences with digital survivorship services and preferences for care...

Delivering cancer survivorship services digitally may increase access for rural populations. This study examined the use of digital health services, digital health readiness, and preferences for survivorship services among cancer survivors treated at a rural comprehensive cancer center.

We identified adults diagnosed with solid tumors from 2022 to 2024 who received treatment at Dartmouth Cancer Center locations. Demographics, visits, referrals, and questionnaires were collected via the health record. A survey was sent to a random sample of cohort patients stratified by tumor type. It assessed digital health readiness, service use and satisfaction, and interest in digital programming. Twenty-five survivors completed qualitative interviews about care experiences and unmet needs. Quantitative data were summarized descriptively; qualitative data were analyzed using a framework analysis.

The cohort included 8772 patients, 80% from rural areas, 81% with an active patient portal account, and 38% with at least one telehealth visit. Behavioral health was mainly delivered as telehealth (76% of visits), whereas cancer-directed specialties delivered < 5% of visits via telehealth. Of the 207 survey respondents, 42% reported using a patient portal often or always to manage their care. Digital health readiness was not associated with patient portal use or interest in digital services. Qualitative data described that digital services would enhance survivorship by facilitating communication with care teams, access to behavioral health, social support, and flexibility regarding visit modality.

Despite perceptions that rural populations lack digital access, we found high engagement with telehealth and interest in digital care for survivorship. Augmenting in-person services with digital programming could improve the reach of survivorship care among rural populations.

Further research is needed to determine preferences for digital care delivery more explicitly across the continuum of survivorship (early, posttreatment, and long-term), as we would anticipate the needs and priorities of cancer survivors shift across time. As the use of digital tools to support information seeking, decision-making, and personal health monitoring expands, the need to support the interface between personal and health care data will require new solutions. Health systems that can deliver integrated digital services that support monitoring during survivorship will be best poised to provide high-quality care to cancer survivors and meet assessment criteria set forth in the national standards.