Advertisement

Bridging the digital divide among advanced age skin cancer patients

Published:September 04, 2021DOI:https://doi.org/10.1016/j.bjps.2021.08.009
      Dear Sir,
      The COVID-19 pandemic has ushered in an increasingly digital age. Innovative technologies (e.g. artificial intelligence for skin cancer screening) and new models of care (e.g. telemedicine services allowing patients to send images of suspicious lesions to their clinicians) have been crucial in allowing skin cancer patients to meet pandemic-related challenges.
      • Zheng D.X.
      • Cullison C.R.
      • Mulligan K.M.
      • Scott J.F
      COVID-19 and the surveillance, epidemiology, and end results program: future considerations for skin cancer research.
      While health information technology (HIT) use among skin cancer patients has significantly increased within the past decade, there remains a “digital divide” in both the access to and utilization of HIT across various demographics of skin cancer patients.
      • Cwalina T.B.
      • Jella T.K.
      • Zheng D.X.
      • et al.
      Utilization of health information technology among skin cancer patients: a cross-sectional study of the National Health Interview Survey from 2011 to 2018.
      We consider that the technological advances made during the pandemic, while potentially beneficial for skin cancer management, may also have the unintended consequence of exacerbating this digital divide.
      In recent years, there has been increased discussion surrounding the use of artificial intelligence to diagnose and monitor potentially malignant skin lesions. While these technologies have traditionally been designed for clinician use, researchers and public health advocates have begun to explore the potential for their use by patients, which may allow for greater convenience of and access to care. In a study by Sangers and colleagues exploring the barriers to and facilitators of use of artificial-intelligence driven mobile health applications for skin cancer screening among the Dutch general population,
      • Sangers T.E.
      • Wakkee M.
      • Kramer-Noels E.C.
      • Nijsten T.
      • Lugtenberg M
      Views on mobile health apps for skin cancer screening in the general population: an in-depth qualitative exploration of perceived barriers and facilitators.
      the authors concluded that creation of low-cost, privacy-friendly, and easy-to-use mobile health applications may encourage adoption of these technologies for skin cancer screening. Integration of mobile health technologies into skin cancer care certainly represents a promising and innovative approach toward facilitating early skin cancer detection. However, given the aforementioned digital divide, increasing adoption of skin cancer screening applications alone may be unlikely to reach the target audience demographic.
      Skin cancer tends to occur in patients of advanced age.
      • Zheng D.X.
      • Cullison C.R.
      • Mulligan K.M.
      • Scott J.F
      COVID-19 and the surveillance, epidemiology, and end results program: future considerations for skin cancer research.
      ,
      • Cwalina T.B.
      • Jella T.K.
      • Zheng D.X.
      • et al.
      Utilization of health information technology among skin cancer patients: a cross-sectional study of the National Health Interview Survey from 2011 to 2018.
      In one study, only 17.0% of individuals ages 65–79 currently owning a smartphone or tablet were interested in using a health-related application to obtain health information.
      • Gordon N.P.
      • Hornbrook M.C
      Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.
      In another retrospective analysis of the National Health Interview Survey, an annual survey of United States households, skin cancer patients age >65 were the least likely age group to utilize HIT, which included using a computer to schedule healthcare appointments, look up health information online, communicate with providers, or fill prescriptions.
      • Cwalina T.B.
      • Jella T.K.
      • Zheng D.X.
      • et al.
      Utilization of health information technology among skin cancer patients: a cross-sectional study of the National Health Interview Survey from 2011 to 2018.
      Furthermore, plastic surgery and dermatology practices have rapidly invested in and expanded upon their telemedicine services due to the COVID-19 pandemic.
      • Simpson C.L.
      • Kovarik C.L
      Effectively engaging geriatric patients via teledermatology.
      Given the high incidence of skin cancer in the elderly and the likely perpetuation of clinical changes related to telemedicine expansion, we believe that investing in the infrastructure to bridge the digital divide among skin cancer patients represents an equally pressing priority to the continued development of technological advances aimed at skin cancer management.
      As we transition into the post-pandemic clinical landscape, plastic surgeons, dermatologists, and other clinicians involved in the management of skin cancer must actively encourage eHealth literacy among their older patients. Simpson and Kovarik present excellent suggestions for engaging geriatric patients via telemedicine.
      • Simpson C.L.
      • Kovarik C.L
      Effectively engaging geriatric patients via teledermatology.
      Helpful interventions might include creating patient education materials describing how to perform medical tasks using a smartphone or computer (e.g. creating an account through the electronic medical record), engaging advanced age patients at time of surgery (e.g. iPads in the room loaded with patient educational videos for post-operative care), and utilizing telemedicine platforms that allow for multiparity encounters which permits older patients the opportunity to attend online visits with a trusted health advocate.
      • Cwalina T.B.
      • Jella T.K.
      • Zheng D.X.
      • et al.
      Utilization of health information technology among skin cancer patients: a cross-sectional study of the National Health Interview Survey from 2011 to 2018.
      ,
      • Simpson C.L.
      • Kovarik C.L
      Effectively engaging geriatric patients via teledermatology.
      These recommendations would help optimize virtual skin cancer care across all demographics, and would especially target the generally lower eHealth literacy of older adults.
      The use of artificial intelligence and associated technological advances to improve early detection of skin cancer is undoubtedly an important aspect of the ever-changing field of digital health. While it is necessary to reduce barriers to use of mobile health screening applications and similar new technologies for the care of skin cancer patients, we must first establish a framework allowing for the equitable distribution of practices related to digital health expansion in the post-pandemic era. Only then can we facilitate optimal utilization of these innovative technologies by their intended patient population.

      Declaration of Competing Interest

      The authors report no conflicts of interest relevant to this work.

      Financial disclosure

      The authors report no funding sources relevant to this work.

      Ethical approval

      Not required.

      References

        • Zheng D.X.
        • Cullison C.R.
        • Mulligan K.M.
        • Scott J.F
        COVID-19 and the surveillance, epidemiology, and end results program: future considerations for skin cancer research.
        J Plast Reconstr Aesthet Surg. 2021;
        • Cwalina T.B.
        • Jella T.K.
        • Zheng D.X.
        • et al.
        Utilization of health information technology among skin cancer patients: a cross-sectional study of the National Health Interview Survey from 2011 to 2018.
        J Am Acad Dermatol. 2021;
        • Sangers T.E.
        • Wakkee M.
        • Kramer-Noels E.C.
        • Nijsten T.
        • Lugtenberg M
        Views on mobile health apps for skin cancer screening in the general population: an in-depth qualitative exploration of perceived barriers and facilitators.
        Br J Dermatol. 2021;
        • Gordon N.P.
        • Hornbrook M.C
        Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.
        BMC Health Serv Res. 2018; 18: 220
        • Simpson C.L.
        • Kovarik C.L
        Effectively engaging geriatric patients via teledermatology.
        J Am Acad Dermatol. 2020; 83: e417-e418