TY  - JOUR
AU  - Chavez-Yenter, Daniel
AU  - Kimball, Kadyn E
AU  - Kohlmann, Wendy
AU  - Lorenz Chambers, Rachelle
AU  - Bradshaw, Richard L
AU  - Espinel, Whitney F
AU  - Flynn, Michael
AU  - Gammon, Amanda
AU  - Goldberg, Eric
AU  - Hagerty, Kelsi J
AU  - Hess, Rachel
AU  - Kessler, Cecilia
AU  - Monahan, Rachel
AU  - Temares, Danielle
AU  - Tobik, Katie
AU  - Mann, Devin M
AU  - Kawamoto, Kensaku
AU  - Del Fiol, Guilherme
AU  - Buys, Saundra S
AU  - Ginsburg, Ophira
AU  - Kaphingst, Kimberly A
PY  - 2021
DA  - 2021/11/18
TI  - Patient Interactions With an Automated Conversational Agent Delivering Pretest Genetics Education: Descriptive Study
JO  - J Med Internet Res
SP  - e29447
VL  - 23
IS  - 11
KW  - cancer
KW  - genetic testing
KW  - virtual conversational agent
KW  - user interaction
KW  - smartphone
KW  - mobile phone
AB  - Background: Cancer genetic testing to assess an individual’s cancer risk and to enable genomics-informed cancer treatment has grown exponentially in the past decade. Because of this continued growth and a shortage of health care workers, there is a need for automated strategies that provide high-quality genetics services to patients to reduce the clinical demand for genetics providers. Conversational agents have shown promise in managing mental health, pain, and other chronic conditions and are increasingly being used in cancer genetic services. However, research on how patients interact with these agents to satisfy their information needs is limited. Objective: Our primary aim is to assess user interactions with a conversational agent for pretest genetics education. Methods: We conducted a feasibility study of user interactions with a conversational agent who delivers pretest genetics education to primary care patients without cancer who are eligible for cancer genetic evaluation. The conversational agent provided scripted content similar to that delivered in a pretest genetic counseling visit for cancer genetic testing. Outside of a core set of information delivered to all patients, users were able to navigate within the chat to request additional content in their areas of interest. An artificial intelligence–based preprogrammed library was also established to allow users to ask open-ended questions to the conversational agent. Transcripts of the interactions were recorded. Here, we describe the information selected, time spent to complete the chat, and use of the open-ended question feature. Descriptive statistics were used for quantitative measures, and thematic analyses were used for qualitative responses. Results: We invited 103 patients to participate, of which 88.3% (91/103) were offered access to the conversational agent, 39% (36/91) started the chat, and 32% (30/91) completed the chat. Most users who completed the chat indicated that they wanted to continue with genetic testing (21/30, 70%), few were unsure (9/30, 30%), and no patient declined to move forward with testing. Those who decided to test spent an average of 10 (SD 2.57) minutes on the chat, selected an average of 1.87 (SD 1.2) additional pieces of information, and generally did not ask open-ended questions. Those who were unsure spent 4 more minutes on average (mean 14.1, SD 7.41; P=.03) on the chat, selected an average of 3.67 (SD 2.9) additional pieces of information, and asked at least one open-ended question. Conclusions: The pretest chat provided enough information for most patients to decide on cancer genetic testing, as indicated by the small number of open-ended questions. A subset of participants were still unsure about receiving genetic testing and may require additional education or interpersonal support before making a testing decision. Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers. 
SN  - 1438-8871
UR  - https://www.jmir.org/2021/11/e29447
UR  - https://doi.org/10.2196/29447
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34792472
DO  - 10.2196/29447
ID  - info:doi/10.2196/29447
ER  -