Increasing Access to Genetic Testing in Underserved Patients Using a Multilingual Conversational Agent

使用多语言会话代理增加服务不足的患者获得基因检测的机会

• 批准号: 10624338
• 负责人: TIMOTHY W. BICKMORE
• 金额: $ 78.25万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624338
• 关键词: Academic Medical Centers; Address; Advanced Malignant Neoplasm; Age; Area; Behavior; California; Cancer Patient; Caring; Clinic; Clinical; Clinical Practice Guideline; Communication; Computers; Counseling; County; Disease; Disparity; Early Diagnosis; Education; Ensure; Epithelial ovarian cancer; Face; Family; Family history of; Family member; Focus Groups; Foundations; Future; Genetic; Genetic Counseling; Genetic Services; Genomics; Goals; Guidelines; Health Personnel; Health education; Healthcare; Hospitals; Individual; Information Technology; Inherited; Internet; Interview; Knowledge; Language; Limited English Proficiency; Linguistics; Los Angeles; Low Literacy Population; Malignant Neoplasms; Malignant neoplasm of male breast; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Measures; Medical center; Modeling; Multilingualism; Oncology; Operative Surgical Procedures; Ovarian; Pancreas; Participant; Patient Care; Patients; Population; Predisposition; Prevention; Prostate; Provider; Randomized, Controlled Trials; Readiness; Recommendation; Recording of previous events; Relative Risks; Research; Resources; Rural Community; Rural Population; Site; Technology; Test Result; Testing; Universities; University Hospitals; Update; Work; access disparities; advanced disease; animation; arm; cancer care; cancer diagnosis; cancer genetics; cancer initiation; cancer risk; cancer type; care outcomes; clinical center; cohort; contextual factors; genetic testing; implementation barriers; implementation context; improved; innovation; literacy; neoplasm resource; non-verbal; novel; patient population; patient subsets; pilot test; primary outcome; randomized trial; recruit; rural setting; safety net; satisfaction; secondary outcome; shared decision making; targeted treatment; testing access; tool; treatment as usual; trial comparing; uptake; usability; verbal

ABSTRACT Background. The volume of patients who meet national criteria for germline genetic testing based on a cancer diagnosis alone, regardless of family history (i.e. ovarian, pancreatic, advanced prostate, etc.) is rapidly growing. Germline genetic test results can inform oncology and surgical treatment decisions, as well as early detection and prevention for the family. However, traditional pre- and post-test genetic counseling approaches may not be sufficient to meet the growing need. Additionally, traditional pre-test counseling may be a barrier, leading to decreased uptake, especially in those with advanced disease. Patients cared for in settings with limited or no genetic services, including low-literacy, non-English speaking, and rural community patients already face disparities in access. As such, these patients remain underrepresented in clinical and research cohorts, and innovative strategies to optimize genetic counseling approaches are understudied. Relational Agents (RAs) are an effective means of automating health education and counseling, as well as overcoming literacy barriers in the use of information technologies. RAs, animated computer characters simulate face-to-face conversation between a patient and a provider using verbal and nonverbal conversational behavior. Overall Goals. This study will develop an English and Spanish RA to communicate personalized pre-test genetic education to a cohort of cancer patients who meet established cancer-based genetic testing criteria across two diverse clinical settings (including a low-resource, urban, safety-net hospital and a university medical center that serves a significant rural population). We hypothesize that the use of an RA will increase the proportion of patients who receive genetic test results within 90 days of initiating cancer care, compared to usual care. Aim 1 is to develop an English- and Spanish-language RA using a patient-driven approach. Aim 2 is to conduct a multisite randomized controlled trial of the RA to deliver pre-test education versus usual care in English- and Spanish-speaking patients to compare the proportion in each arm who receive genetic test results in 90 days at Los Angeles County+University of Southern California Medical Center and University of Rochester Medical Center. Aim 3 is to understand the implementation context and identify facilitators and barriers to utilizing the RA in these clinical settings. Impact. Our deliverable will be multilingual patient-facing RA to deliver pre-test genetic education. This RA will be developed and evaluated in two distinct patient populations and clinic workflows, can be rapidly updated as practice evolves, and will ultimately be available on the internet for clinics and patients to utilize. If successful, this would be a novel, effective, and scalable means of providing genetics education that could improve patient decisional preparedness, knowledge, and satisfaction, ultimately leading to increased access for patient populations who are traditionally underserved in genetics. Understanding the implementation context and identifying facilitators and barriers to integrating a RA will increase sustainability and generalizability.

摘要