Conversational Agents to Improve Quality of Life in Palliative Care

 描述（由申请人提供）： 虽然现在已经开发了许多干预措施来解决特定慢性病的姑息治疗，但在解决患有严重疾病的老年人的整体生活质量方面几乎没有做过什么，不仅包括症状和药物管理的功能方面，而且还包括以可扩展和具有成本效益的方式进行痛苦的情感方面。在过去的十年里，我们已经开发和测试了体现会话代理（ECA）-计算机字符，模拟面对面的谈话，使用语音，手势，凝视线索和其他非语言的会话行为，以提供一个自然和直观的计算机界面，能够表达同理心和其他情绪。我们已经成功地开发和评估了这个接口在几个临床试验，涉及老年患者的所有水平的健康和计算机素养。我们现在建议采用这种创新的尖端技术，为晚期疾病患者创建和测试移动的ECA姑息治疗（ECA-PAL），包括：症状和药物跟踪和管理;评估和咨询，以减少社会孤立，抑郁和未满足的精神需求;以及，促进和沟通有关预先护理计划。设计图：随机对照试验假设：与接受常规治疗的受试者相比，ECA-PAL受试者将：（1）生活质量更高;（2）接受姑息治疗服务的比例更高;（3）医院服务利用率更低;以及（4） 降低每个患者月的费用。研究人群：在波士顿医疗中心或附属健康中心的患有限制生命疾病的成年患者，其临床医生认可如果患者在12个月内死亡也不会令人惊讶。方法：将通过一项随机对照试验对接受常规治疗（n=182）或常规治疗加ECA-PAL（n=182）的患者进行ECA-PAL评估。每例受试者将与一名护理者代理受试者一起入组沿着。结果测量：主要结果是生活质量。次要结果将在姑息治疗服务的接受、医院服务利用、成本、社会隔离、抑郁、焦虑、身体症状、精神需求、预先护理计划等领域进行测量。照顾者也将接受采访，以衡量他们的生活质量。预期结果：在这个项目中，我们将评估一种可扩展的以患者为中心的干预措施，以改善晚期疾病患者的生活质量。

 DESCRIPTION (provided by applicant): Although many interventions have now been developed to address palliative care for specific chronic diseases, little has been done to address the overall quality of life for older adults with serious illness, spanning not only the functional aspects of symptom and medication management, but the affective aspects of suffering in a scalable and cost effective manner. Over the past decade we have developed and tested embodied conversational agents (ECA) - computer characters that simulate face- to-face conversation using voice, hand gesture, gaze cues and other nonverbal conversational behavior to provide a natural and intuitive computer interface that is capable of expressing empathy and other emotions. We have successfully developed and evaluated this interface in several clinical trials involving older patients of all levels of health and computer literacy. We now propose to adapt this innovative cutting edge technology to create and test a mobile ECA for palliative care (ECA-PAL) for patients with advanced illnesses, spanning: symptom and medication tracking and management; assessment and counseling to reduce social isolation, depression and unmet spiritual needs; and, promotion of and communication about advance care plan. Design: Randomized Controlled Trial Hypotheses: In comparison to participants receiving usual care, ECA-PAL participants will: (1) have greater quality of life; (2) a higher rat of receiving of palliative care services; (3) a lower rate of hospital service utilization; and (4) lower cost per patient-month. Population Studied: Adult patients at Boston Medical Center or affiliated Health Centers with life-limiting illness, whose clinician endorses that it would not bea surprise if the patient died within 12 months. Methods: The ECA-PAL will be assessed with a randomized controlled trial of patients getting usual care (n=182) or usual care plus ECA-PAL (n=182). Each participant will be enrolled along with a caregiver surrogate subject. Outcome Measures: The primary outcome is quality of life. Secondary outcomes will be measured in the domains of receipt of palliative care services, hospital service utilization, cost, social isolatio, depression, anxiety, physical symptoms, spiritual needs, advance care planning. Caregivers will also be interviewed to measure their quality of life. Expected Results: In this project we will evaluate a scalable patient-centered intervention to improve the quality of life for people with advanced illnesses.