Conversational Agents to Improve Quality of Life in Palliative Care

背景：虽然现在已经开发了许多干预措施来解决姑息治疗， 尽管老年人患有特定的慢性疾病，但在解决老年人的整体生活质量方面做得很少， 严重疾病，不仅涵盖症状和药物管理的功能方面， 以一种可扩展的、具有成本效益的方式来解决痛苦的情感方面。在过去的十年里， 开发并测试了具身会话代理（ECA）-模拟人脸的计算机角色- 使用语音、手势、凝视暗示和其他非语言会话行为的面对面会话 为了提供自然和直观的计算机界面，该计算机界面能够表达同情心和其他情感， 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， 所有健康水平的老年患者和计算机知识。我们现在建议采用这种创新的 尖端技术，为患有以下疾病的患者创建和测试用于姑息治疗的移动的ECA（ECA-PAL） 晚期疾病，涵盖：症状和药物跟踪和管理;评估和 提供咨询，以减少社会孤立、抑郁和未满足的精神需求;以及，促进和 关于提前护理计划的沟通。 设计：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） 生活质量提高;（2）接受姑息治疗服务的比率提高;（3）住院率降低 服务利用率;（4）降低了每病人月的费用。 研究人群：波士顿医疗中心或附属健康中心的成人患者， 世卫组织的临床医生表示，如果患者在12个月内死亡，也不会令人惊讶。 方法：ECA-PAL将通过一项随机对照试验进行评估， 治疗组（n=182）或常规治疗加ECA-PAL组（n=182）。每名参与者将沿着一起入组， 看护者替代对象。 结果测量：主要结果是生活质量。次要结局将在 接受姑息治疗服务的领域，医院服务利用，成本，社会隔离， 抑郁、焦虑、身体症状、精神需求、提前护理计划。护理人员也将 来衡量他们的生活质量。 预期结果：在本项目中，我们将评估一个可扩展的以患者为中心的干预措施，以改善 晚期病人的生活质量。

Background: 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 planning. 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 rate 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, who’s clinician endorses that it would not be a 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 isolation, 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.