Although this seems unlikely in our always-online, hyperconnected society, some people do not — or are unable to — rely on electronic media for communication. As a result, some people inadvertently fall through the cracks when it comes to outreach and education about COVID-19, including vaccines, that focuses primarily on electronic methods of communication. Unfortunately, that can widen disparities that already exist in some marginalized patient populations. 

A team of researchers wanted to identify and find ways to contact patients who may benefit from nonelectronic forms of outreach. The results of their work were published as a research letter in JAMA Oncology

The researchers started by identifying cancer patients through use of the electronic health system at the North Carolina Cancer Hospital of the University of North Carolina (UNC) Health System, beginning in January 2021. They searched the database for patients who had received cancer treatment within the past year with follow-up scheduled but who did not have an active patient portal or valid email address on file. They also searched for patients who lived in a county with a 20% or greater poverty rate. They ended up with a pool of 536 people who were potentially marginalized and also eligible for COVID-19 vaccination. Of the 536, 172 were Black and 326 were non-Hispanic White, and 70 came from counties with persistent poverty.

Continue Reading

Then, a group of 4 nurses called each patient and used a specially developed script about their eligibility for COVID-19 vaccination, as well as information about the logistics and safety of the vaccines. “Their approach was to aid patients in making informed decisions about vaccination, address identified barriers to vaccination when able, and respond to patients’ questions and concerns,” the researchers noted. 

At the end of the study in early April, 26% of the 359 patients who were contacted had gotten vaccinated, and 14% had a vaccination appointment scheduled. 

This particular study did not have a control arm, so that is one possible limitation. The researchers also noted the possibility of an underestimation of vaccination rates, too, as some patients potentially could have gotten vaccinated on their own and the information might not have made it into their UNC electronic health record. 

Even so, “preliminary qualitative feedback from patients suggests that the calls aided them in their decision to proceed with vaccination,” the researchers wrote, adding that the calls also uncovered other unmet clinical or social needs affecting the patients, which provided an opportunity to help them.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Stein J, Fasold M, Daguerre KJ, et al. Use of an analytics and electronic health record-based approach for targeted COVID-19 vaccine outreach to marginalized populations. JAMA Oncol. Published online August 19, 2021. doi:10.1001/jamaoncol.2021.3833