Improving PRO Interpretation at the Individual Level for Patients with Cancer using Conversational Agents and Data Visualization

越来越多的人认识到患者报告的结果(PRO)对于健康评估的重要性- 研究和临床环境中的相关生活质量。对于具有内在主观性的人来说，职业尤其重要 但关键的临床现象，如疼痛、情绪和疲劳。尽管对专业人士进行了大量研究，但担忧 关于可靠性和有效性的问题一直存在，特别是在个人层面上使用时，特别是在 可能很难理解专业问题，例如那些健康素养较低或未发现认知能力的人 减损。在过去的十年里，我们开发并测试了一种工具，该工具具有在以下方面增强专业人员的潜力 个体层次具体化对话代理(ECA)，是模拟面孔的计算机角色- 使用语音、手势、凝视暗示和其他非语言行为进行面对面交谈。我们已经成功地 在健康素养有限的人群、老年患者和患者的行为干预中使用它们 得了癌症。面对面的接触，结合图片支持的书面说明，仍然是一种 通常是交流信息的最佳方法，但对于具有以下特点的个人尤其有效 健康素养有限。我们还演示了ECA可以用作标准的有效替代方案 物质使用筛查的纸质调查，以及对患者和其他人的同理心的展示 随着时间的推移，ECA的关系行为会导致患者参与度的增加。我们将调整我们先前的工作 在ECA上产生ECA-PRO，这是一个使用对患者的ECA随着时间的推移管理PRO的框架 智能手机有英语和西班牙语版本。ECA-PRO系统将包括新的用户界面，以优化 使用清晰的可视化将结果传达给患者和临床医生。为了证明可概括性 对于ECA-PRO，我们将重点关注两个临床情景：1)对患者的症状和生活质量进行纵向监测 接受癌症治疗的患者，以及2)监测长期服药患者的服药依从性 口服抗癌药物。我们假设ECA-PRO系统是为个人患者级别设计的 互动和数据收集，将提高PROS的可靠性、有效性和总体临床相关性 在癌症治疗期间收集的。我们将开发和评估PRO系统，使患者与 交互式沟通和同理心，同时以最大限度地减少丢失数据的方式提供标准专业知识 并实现用户友好的结果可视共享。非洲经委会-PRO系统将为 以PRO为基础的临床决策。如果成功，这些工具可以迅速和广泛地传播。

There is increasing recognition of the importance of patient-reported outcomes (PROs) for assessment of health- related quality of life in both research and clinical settings. PROs are especially important for inherently subjective but crucial clinical phenomena such as pain, mood, and fatigue. Despite much research in PROs, concerns about reliability and validity persist, especially when used at the individual level, particularly among patients who may struggle to understand PRO questions, such as those with low health literacy or undetected cognitive impairment. Over the past decade, we have developed and tested a tool with the potential to enhance PROs at the individual level – embodied conversational agents (ECA), which are computer characters that simulate face- to-face conversation using voice, hand gestures, gaze cues and other nonverbal behavior. We have successfully used them in behavioral interventions for populations with limited health literacy, elderly patients, and patients with cancer. Face-to-face encounters, in conjunction with written instructions supported by pictures, remains one of the best methods for communicating information in general, but is particularly effective for individuals with limited health literacy. We have also demonstrated that ECAs can be used as valid alternatives to standard paper-based surveys for substance use screening, and that the display of empathy for patients and other relational behavior by ECAs leads to increased engagement by patients over time. We will adapt our prior work on ECAs to produce ECA-PRO, a framework for administering PROs over time using an ECA on patients’ smartphones in English and Spanish. The ECA-PRO system will include novel user interfaces to optimally communicate the results to patients and clinicians using clear visualizations. To demonstrate the generalizability of ECA-PRO, we will focus on two clinical scenarios: 1) longitudinal monitoring of symptoms and quality of life in patients undergoing cancer treatment, and 2) monitoring of medication adherence in patients taking long-term oral anti-cancer drugs. We hypothesize that the ECA-PRO system, designed for individual-patient-level interactions and data collection, will improve the reliability, validity, and overall clinical relevance of PROs collected during cancer treatment. We will develop and evaluate a PRO system that engages patients with interactive communication and empathy, while delivering standard PROs in a way that minimizes missing data and enables user-friendly visual sharing of results. The ECA-PRO system will create a strong foundation for PRO-based clinical decision-making. If successful, these tools can be rapidly and broadly disseminated.