Patient assessment of chatbots for the scalable delivery of genetic counseling

Schmidlen, Tara; Schwartz, Marci; DiLoreto, Kristy; Kirchner, H. Lester; Sturm, Amy C.

doi:10.1002/jgc4.1169

Cited by 108 publications

(127 citation statements)

References 26 publications

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“…Similar to the previous review, most recent studies were aimed at mental health self-management (n=5) [ 10 - 12 ]. Single studies (n=3) used virtual assistants to provide patients with education and support for breast cancer [ 13 ], genetic counseling [ 14 ], and clinician training [ 15 ]. Despite the potential for natural language virtual assistants to provide personalized information and support users to engage in positive health behaviors, only three natural language processing virtual assistants focus on lifestyle modification.…”

Section: Introductionmentioning

confidence: 99%

A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study

Maher¹,

Davis²,

Curtis³

et al. 2020

JMIR Mhealth Uhealth

179

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Background Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. Objective This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. Methods This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. Results Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events). Conclusions An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted.

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Section: Introductionmentioning

confidence: 99%

A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study

Maher¹,

Davis²,

Curtis³

et al. 2020

JMIR Mhealth Uhealth

179

View full text Add to dashboard Cite

show abstract

“…For example, there is room for further work in exploring the cost savings related to having a GCA in specialty areas other than cancer, which will be important as justification is often needed for the creation of new positions (Hallquist et al, 2020; Pirzadeh‐Miller et al, 2017). In addition, genetic counselors will continue to push toward increasingly innovative models of services delivery such as the incorporation of chatbots for consent and other tasks (Schmidlen, Schwartz, DiLoreto, Kirchner, & Sturm, 2019). Finally, the COVID‐19 pandemic is highlighting the need for varied SDMs as well as updated reimbursement models, and it is demonstrating the capability for change when significant barriers are removed.…”

Section: Discussionmentioning

confidence: 99%

Genetic counseling service delivery models: A study of genetic counselors’ interests, needs, and barriers to implementation

Boothe

Greenberg

Delaney

et al. 2020

Journal of Genetic Counseling

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As demand for genetic services grows, innovative genetic counseling service delivery models (SDMs) are needed. However, there is limited research on the barriers and needs of genetic counselors (GCs) interested in implementing new SDMs into their practice. In fall 2017, the National Society of Genetic Counselors (NSGC) Access and Service Delivery Committee’s SDM Subcommittee sent an online survey to the NSGC membership regarding the use of SDMs, which aimed to update the understanding of current SDM use and how this has changed over time. The survey included several questions with open‐response components assessing the need for new SDMs and barriers to implementation. Inductive thematic analysis was used to identify common themes. Among 517 usable responses (16% response rate), more than half (54.4%) of respondents indicated their current SDM was inadequate to address the patient need in their area. Nearly two‐thirds (64.8%) indicated they were in the process of or planning to make changes to their SDM, although 40.6% did not have a specific timeline. Three major themes related to expanding access, reimbursement for services, and lack of support were identified from responses to questions about implementation of additional SDMs. Access included subthemes of geographic and physical location limitations, addressing long wait times, and the need to expand services. Reimbursement for services included issues with billing, genetic counselor licensure, and limitations due to the need for physician involvement in billing. The lack of support was evident with issues related to understaffing; difficulty gaining support at the administrative, institutional, or physician level; time constraints; and funding concerns. This study shows that GCs need education, tools, and resources to overcome barriers in implementing new or adapting current SDMs, and there is a need for policy change, including new billing and coverage models.

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“…As such, both are ethical concerns for a genetic counselor. Owing to the challenges of building meaningful short‐term relationships with patients and overcoming sociocultural biases, genetic counselors should continue to conduct research that explores best practices for maximizing the value of short‐term interactions with patients (Buchanan, Rahm, & Williams, ; Cloutier et al, ; Schmidlen, Schwartz, DiLoreto, Kirchner, & Sturm, ) and promote self‐awareness about how sociocultural biases impact counseling processes and outcomes (Schaa et al, ).…”

Section: An Adapted Ethical Frameworkmentioning

confidence: 99%

An ethical framework for genetic counseling in the genomic era

Jamal

Schupmann

Berkman

2019

Journal of Genetic Counseling

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Since the inception of their profession, genetic counselors have helped patients and families adapt to varied circumstances and make decisions influenced by powerful emotions. In doing so, they have had to reconcile ethical principles with the diverse values of their patients. While this challenge is not unique in medicine, it has preoccupied genetic counselors disproportionately because such a large share of genetic counseling work involves nuanced discussions about reproductive choices and the impact of difference and disability on people's lives. Historically, the profession of genetic counseling has relied on 'nondirectiveness' to guide practice. Nondirectiveness has been defined in various ways: as a counseling method designed to be value-neutral (Caplan, 1993); as the prevention of coercion or persuasion in genetic counseling(Hamby & Biesecker, 2000); as a commitment not to impose one's own values on patients (Fine, 1993); and as a counseling strategy that supports autonomous decision-making (Bartels, LeRoy, McCarthy, & Caplan, 1997). The original ethical justification for practicing nondirectively was to respect individual patient autonomy, construed largely as non-interference in patient decision-making (Stern, 2009). This ethos grew out of a genuine respect for persons, particularly concerning reproductive choice and disability rights. The profession's emphasis on nondirectiveness has also been understood as an effort to distance genetic counseling from the morally fraught history of eugenics (Resta, 1997).

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Patient assessment of chatbots for the scalable delivery of genetic counseling

Cited by 108 publications

References 26 publications

A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study

A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study

Genetic counseling service delivery models: A study of genetic counselors’ interests, needs, and barriers to implementation

An ethical framework for genetic counseling in the genomic era

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