Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study (Preprint)

Abstract

BACKGROUND Genetic testing has become an integrated part of the health care for patients with breast or ovarian cancer, and the increasing demand of genetic testing is accompanied by an increasing need of easy access to reliable genetic information for patients. We therefore developed an app (named Rosa), a virtual assistant able to perform human-like digital conversations about genetic BRCA-testing, using chatbot technology. OBJECTIVE Before implementing this new information service in daily clinical practice, we wanted to explore two aspects of chatbot use: 1) The perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer, and 2) How interaction with a chatbot regarding sensitive information about hereditary cancer, influences the patients. METHODS A total of 175 healthy individuals at risk of hereditary breast and ovarian cancer, were invited to test the chatbot Rosa before and after genetic counseling. Among 61 participants that consented for individual interview, a selected subgroup of 16 subjects shared their experience through in-depth interviews over video. To secure a varied sample, the participants were recruited from all cancer genetic clinics in Norway and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. RESULTS The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability, and that they could have access wherever they were. The fact that Rosa was created by health care professionals made them feel safe that they received medically correct information. It was referred to as an alternative to Google, only better, since it provided specific and reliable answers to their questions. All participants denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. CONCLUSIONS This study shows that chatbot use in clinical genetic practice contributes to uniform information for our patients, regardless of residence and access to specialized healthcare personnel, without adding discomfort or worry. The availability of quality assured information, tailored to the specific situation the patient is facing, has had a reassuring effect on the participants. This indicates that a chatbot can be a well-suited companion to genetic counseling, however we found no evidence supporting that Rosa could replace genetic counseling.

Validation of a guidelines-based digital tool to assess the need for germline cancer genetic testing

“…The high level of agreement between the tool and GCs that we observed, combined with prior research on feasibility and acceptability of genomics digital tools, 27,33,[36][37][38][43][44][45] supports them as promising solutions to increasing access to hereditary cancer risk assessment without burdening clinicians. In a recent systematic review, Lee et al found that 84% of 87 studies on digital tools in genomics reported a positive outcome and that digital tools increased provider efficiency and decreased the time providers need to spend with patients 36 .…”