Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Priscilla K. Gazarian

Second Advisor

C. Ann Gakumo

Third Advisor

Lisa Kennedy Sheldon


This study investigates the role of Health Information Technology (HIT) in the process of patient engagement in treatment decision making in older adults in cancer care. Despite the role of HIT in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults, where the burden of cancer is high. This is a secondary data analysis of a subset of the Health Information National Trend Survey (HINTS 4, Cycle 3). The subset includes individuals 65 years old and above. The relationships between access to and utilization of HIT (for those with and without a cancer diagnosis) to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Chi-square, logistic regression, and linear regression models were fit to study these associations. No significant differences between the access and utilization of HIT and the diagnosis of cancer were found in the two groups. The results of this analysis indicated that lower than a college education level, being non-white and living in poverty were significantly associated with access to HIT. The utilization of HIT was associated with lower than a college education level and living in poverty. This analysis also indicated that cancer fatalistic beliefs were significantly associated with the lower utilization of HIT. Specifically, a one-point increase in cancer fatalistic belief score is associated with a 59% decrease in the utilization of HIT. The self-management domain of the patient activation (which is a precursor of the engagement process) was significantly associated with access to and utilization of HIT, indicating that HIT is one of the vital tools for enhancing the patient engagement process in older adults. This is vital information for providers and policy researchers to take into account for future implementation strategies of HIT in cancer care.


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