Clinical, Legal, and Ethical Aspects of Artificial Intelligence–Assisted Conversational Agents in Health Care

McGreevey, John D.; Hanson, C. William; Koppel, Ross

doi:10.1001/jama.2020.2724

Cited by 69 publications

(48 citation statements)

References 5 publications

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“…2 Jessica Duncan Cance, MPH, PhD Erin Doyle, MS In Reply Dr Darcy and colleagues from Woebot Health cite 2 references when suggesting that the CA field is more developed than our Viewpoint suggested. 1 However, we find the use of these references as being off target for 2 reasons. First, both articles address symptom checkers.…”

Section: Related Article Page 2440mentioning

confidence: 99%

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Changes in Outpatient Buprenorphine Dispensing During the COVID-19 Pandemic

Cance

Doyle

2020

JAMA

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Section: Related Article Page 2440mentioning

confidence: 99%

“…Drug overdose prevention remains critical during the coronavirus disease 2019 (COVID-19) pandemic. 1 Buprenorphine for treatment of opioid use disorder reduces the likelihood of opioid overdose and can be prescribed in office-based outpatient settings. 2,3 On March 13, 2020, the COVID-19 outbreak was declared a national emergency.…”

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confidence: 99%

Changes in Outpatient Buprenorphine Dispensing During the COVID-19 Pandemic

Cance

Doyle

2020

JAMA

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“…Recently, carefully designed conversational agents (CAs) have been showing promise in automating several health care services [5] by simulating human support. CAs could therefore be uniquely poised to offer high-quality digital interventions for mental health.…”

Section: Introductionmentioning

confidence: 99%

Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study

Darcy¹,

Daniels²,

Salinger³

et al. 2021

JMIR Form Res

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Background There are far more patients in mental distress than there is time available for mental health professionals to support them. Although digital tools may help mitigate this issue, critics have suggested that technological solutions that lack human empathy will prevent a bond or therapeutic alliance from being formed, thereby narrowing these solutions’ efficacy. Objective We aimed to investigate whether users of a cognitive behavioral therapy (CBT)–based conversational agent would report therapeutic bond levels that are similar to those in literature about other CBT modalities, including face-to-face therapy, group CBT, and other digital interventions that do not use a conversational agent. Methods A cross-sectional, retrospective study design was used to analyze aggregate, deidentified data from adult users who self-referred to a CBT-based, fully automated conversational agent (Woebot) between November 2019 and August 2020. Working alliance was measured with the Working Alliance Inventory-Short Revised (WAI-SR), and depression symptom status was assessed by using the 2-item Patient Health Questionnaire (PHQ-2). All measures were administered by the conversational agent in the mobile app. WAI-SR scores were compared to those in scientific literature abstracted from recent reviews. Results Data from 36,070 Woebot users were included in the analysis. Participants ranged in age from 18 to 78 years, and 57.48% (20,734/36,070) of participants reported that they were female. The mean PHQ-2 score was 3.03 (SD 1.79), and 54.67% (19,719/36,070) of users scored over the cutoff score of 3 for depression screening. Within 5 days of initial app use, the mean WAI-SR score was 3.36 (SD 0.8) and the mean bond subscale score was 3.8 (SD 1.0), which was comparable to those in recent studies from the literature on traditional, outpatient, individual CBT and group CBT (mean bond subscale scores of 4 and 3.8, respectively). PHQ-2 scores at baseline weakly correlated with bond scores (r=−0.04; P<.001); however, users with depression and those without depression had high bond scores of 3.45. Conclusions Although bonds are often presumed to be the exclusive domain of human therapeutic relationships, our findings challenge the notion that digital therapeutics are incapable of establishing a therapeutic bond with users. Future research might investigate the role of bonds as mediators of clinical outcomes, since boosting the engagement and efficacy of digital therapeutics could have major public health benefits.

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“…The subsequent ability for the clinician to hone in on the patient's personal concerns during a limited appointment slot can deepen the quality of their interaction. Initial data also suggests that chatbots can help with remote patient management and allow clinicians to focus on other higher‐level activities (McGreevey et al., 2020). This not only benefits patients who are making critical decisions about how to integrate genetic information into their lives, but may also contribute to greater clinician job satisfaction.…”

Section: Introductionmentioning

confidence: 99%