JMIR Publications

ABSTRACT

Background:

Genetic testing has become an integrated part of the health care for patients with breast or ovarian cancer, and the increasing demand of genetic testing is accompanied by an increasing need of easy access to reliable genetic information for patients. We therefore developed an app (Rosa), a virtual assistant able to perform human-like digital conversations about genetic BRCA-testing, using chatbot technology.

Objective:

Before implementing this new information service in daily clinical practice, we wanted to explore two aspects of chatbot use: 1) The perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer, and 2) How interaction with a chatbot regarding sensitive information about hereditary cancer, influences the patients.

Methods:

A total of 175 healthy individuals at risk of hereditary breast and ovarian cancer, were invited to test the chatbot Rosa before and after genetic counseling. To secure a varied sample, the participants were recruited from all cancer genetic clinics in Norway and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among 61 participants that consented for individual interview, a selected subgroup of 16 subjects shared their experience through in-depth interviews over video. The semi-structured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa impacted the user, and thoughts on future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive (SDI) approach.

Results:

The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were, the possibility to use it to prepare for genetic counseling, and to repeat/ask questions about what had been said afterwards. Because Rosa was created by health care professionals, they also valued the information they received as medically correct. Rosa was referred to as better than Google since it provided specific and reliable answers to their questions. The findings were summed up in three concepts: “Anytime, anywhere”, “In addition, not instead” and “Trustworthy and true”. All participants denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa.

Conclusions:

Our results indicate that a genetic information chatbot has the potential to contribute to easy access of uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geography. The 24/7 availability of quality assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition however no participants supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling.