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

摘要 背景资料。符合国家癌症生殖系基因检测标准的患者数量 单独诊断，而不考虑家族史(如卵巢、胰腺、晚期前列腺癌等)正在迅速增长。 生殖系基因测试结果可以为肿瘤学和外科治疗决策提供信息，以及早期发现 以及对家庭的预防。然而，传统的测试前和测试后的遗传咨询方法可能不是 足以满足日益增长的需求。此外，传统的考前咨询可能是一个障碍，导致 摄取减少，特别是在那些患有晚期疾病的人。患者在有限或没有的环境中接受护理 遗传服务，包括低识字率、非英语国家和农村社区患者已经面临 获取方面的差距。因此，这些患者在临床和研究队列中的代表性仍然不足， 优化遗传咨询方法的创新战略尚未得到充分研究。关系代理(RAS) 是自动化健康教育和咨询以及克服识字的有效手段 在使用信息技术方面的障碍。RAS，计算机动画角色模拟面对面 病人和提供者之间的对话，使用语言和非语言的对话行为。总括 目标。这项研究将开发一个英语和西班牙语的RA来交流个性化的测试前基因 对一群符合既定癌症基因检测标准的癌症患者进行教育 多样化的临床环境(包括低资源、城市、安全网医院和大学医疗中心 服务于大量农村人口)。我们假设，使用RA将增加 与通常的治疗相比，在癌症治疗开始后90天内收到基因检测结果的患者。目标 1是开发一种以患者为导向的英语和西班牙语RA。目标2是进行一项 RA的多点随机对照试验，提供考试前教育与普通英语护理--以及 西班牙语患者比较90天内每条手臂接受基因检测结果的比例 洛杉矶县+南加州大学医学中心和罗切斯特大学医学 中心。目标3是了解实施环境，并确定利用 在这些临床环境中的RA。冲击力。我们的交付内容将是面向患者的多语言RA，以提供预测试 基因教育。这种类风湿关节炎将在两个不同的患者群体和临床中进行开发和评估 工作流程，可以随着实践的发展而快速更新，并最终将在互联网上提供给诊所 和病人来利用。如果成功，这将是一种提供遗传学的新颖、有效和可扩展的方法 教育可以提高患者的决策准备、知识和满意度，最终导致 增加传统上在遗传学方面得不到充分服务的患者群体的机会。了解 实施背景和确定整合RA的促进者和障碍将增加可持续性和 概括性。

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.