Improving electronic survey response rates among cancer center patients during the COVID-19 pandemic: Mixed methods pilot study

Cassandra A. Hathaway, Melody N. Chavez, Mika Kadono, Dana Ketcher, Dana E. Rollison, Erin M. Siegel, Anita R. Peoples, Cornelia M. Ulrich, Frank J. Penedo, Shelley S. Tworoger, Brian D. Gonzalez

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Surveys play a vital role in cancer research. During the COVID-19 pandemic, the use of electronic surveys is crucial to improve understanding of the patient experience. However, response rates to electronic surveys are often lower compared with those of paper surveys. Objective: The aim of this study was to determine the best approach to improve response rates for an electronic survey administered to patients at a cancer center during the COVID-19 pandemic. Methods: We contacted 2750 patients seen at Moffitt Cancer Center in the prior 5 years via email to complete a survey regarding their experience during the COVID-19 pandemic, with patients randomly assigned to a series of variations of prenotifications (ie, postcard, letter) or incentives (ie, small gift, modest gift card). In total, eight combinations were evaluated. Qualitative interviews were conducted to understand the level of patient understanding and burden with the survey, and quantitative analysis was used to evaluate the response rates between conditions. Results: A total of 262 (9.5%) patients completed the survey and 9 participated in a qualitative interview. Interviews revealed minimal barriers in understanding or burden, which resulted in minor survey design changes. Compared to sending an email only, sending a postcard or letter prior to the email improved response rates from 3.7% to 9.8%. Similarly, inclusion of an incentive significantly increased the response rate from 5.4% to 16.7%, especially among racial (3.0% to 12.2%) and ethnic (6.4% to 21.0%) minorities, as well as among patients with low socioeconomic status (3.1% to 14.9%). Conclusions: Strategies to promote effective response rates include prenotification postcards or letters as well as monetary incentives. This work can inform future survey development to increase response rates for electronic surveys, particularly among hard-to-reach populations.

Original languageEnglish (US)
Article numbere30265
JournalJMIR Cancer
Issue number3
StatePublished - Jul 2021
Externally publishedYes

Bibliographical note

Funding Information:
This research was made possible through the Total Cancer Care Protocol and by the Participant Research, Interventions & Measurement (PRISM) Core Facility at the H. Lee Moffitt Cancer Center & Research Institute, an NCI-designated Comprehensive Cancer Center (P30-CA076292). DK was supported by T32-CA090314 (principal investigators: Susan T Vadaparampil and Thomas H Brandon).

Publisher Copyright:
© Cassandra A Hathaway, Melody N Chavez, Mika Kadono, Dana Ketcher, Dana E Rollison, Erin M Siegel, Anita R Peoples, Cornelia M Ulrich, Frank J Penedo, Shelley S Tworoger, Brian D Gonzalez.


  • COVID-19
  • Cancer
  • Cancer patients
  • Digital health
  • Electronic survey
  • Health outcomes
  • Health promotion
  • Pandemic
  • Patient experience
  • Response rates
  • Surveillance


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