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

使用多语言会话代理增加服务不足的患者获得基因检测的机会

• 批准号: 10444758
• 负责人: TIMOTHY W. BICKMORE
• 金额: $ 79.54万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444758
• 关键词: Academic Medical Centers; Address; Advanced Malignant Neoplasm; Age; Area; Behavior; California; Cancer Patient; Caring; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Computers; Counseling; County; Disease; Early Diagnosis; Education; Ensure; Epithelial ovarian cancer; Face; Family; Family history of; Family member; Focus Groups; Foundations; Future; Genetic; Genetic Counseling; Genetic Services; Genomics; Goals; Guidelines; Health Personnel; Health education; Healthcare; Hospitals; Individual; Information Technology; Inherited; Internet; Interview; Knowledge; Language; Limited English Proficiency; Linguistics; Los Angeles; Low Literacy Population; Malignant Neoplasms; Malignant neoplasm of male breast; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Measures; Medical center; Modeling; Multilingualism; Oncology; Operative Surgical Procedures; Ovarian; Pancreas; Participant; Patient Care; Patients; Population; Pre-Post Tests; Predisposition; Prevention; Prostate; Provider; Randomized Controlled Trials; Readiness; Recording of previous events; Relative Risks; Resources; Rural Community; Rural Population; Site; Technology; Test Result; Testing; Time; Universities; University Hospitals; Update; Work; advanced disease; arm; base; cancer care; cancer diagnosis; cancer genetics; cancer risk; cancer type; care outcomes; clinical center; cohort; contextual factors; genetic testing; implementation barriers; implementation context; improved; innovation; literacy; neoplasm resource; novel; patient population; patient subsets; pilot test; primary outcome; randomized trial; recruit; rural setting; safety net; satisfaction; secondary outcome; shared decision making; targeted treatment; testing access; tool; treatment as usual; trial comparing; uptake; usability; Academic Medical Centers; Address; Advanced Malignant Neoplasm; Age; Area; Behavior; California; Cancer Patient; Caring; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Computers; Counseling; County; Disease; Early Diagnosis; Education; Ensure; Epithelial ovarian cancer; Face; Family; Family history of; Family member; Focus Groups; Foundations; Future; Genetic; Genetic Counseling; Genetic Services; Genomics; Goals; Guidelines; Health Personnel; Health education; Healthcare; Hospitals; Individual; Information Technology; Inherited; Internet; Interview; Knowledge; Language; Limited English Proficiency; Linguistics; Los Angeles; Low Literacy Population; Malignant Neoplasms; Malignant neoplasm of male breast; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Measures; Medical center; Modeling; Multilingualism; Oncology; Operative Surgical Procedures; Ovarian; Pancreas; Participant; Patient Care; Patients; Population; Pre-Post Tests; Predisposition; Prevention; Prostate; Provider; Randomized Controlled Trials; Readiness; Recording of previous events; Relative Risks; Resources; Rural Community; Rural Population; Site; Technology; Test Result; Testing; Time; Universities; University Hospitals; Update; Work; advanced disease; arm; base; cancer care; cancer diagnosis; cancer genetics; cancer risk; cancer type; care outcomes; clinical center; cohort; contextual factors; genetic testing; implementation barriers; implementation context; improved; innovation; literacy; neoplasm resource; novel; patient population; patient subsets; pilot test; primary outcome; randomized trial; recruit; rural setting; safety net; satisfaction; secondary outcome; shared decision making; targeted treatment; testing access; tool; treatment as usual; trial comparing; uptake; usability

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.

抽象的 背景。根据癌症符合种系基因测试标准的患者的体积 仅诊断，无论家族史（即卵巢，胰腺，晚期前列腺等）如何诊断。 种系遗传测试结果可以为肿瘤学和手术治疗决定以及早期检测提供信息 和家庭预防。但是，传统的预测试前和后遗传咨询方法可能不是 足以满足日益增长的需求。此外，传统的测试咨询可能是一个障碍，导致 摄取减少，尤其是在患有晚期疾病的患者中。在有限或没有的设置中受到照顾的患者 遗传服务，包括低文字，非英语和农村社区患者已经面对 访问差异。因此，这些患者在临床和研究队列中的人数不足，并且 研究了优化遗传咨询方法的创新策略。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 使用信息技术的障碍。 RAS，动画计算机字符对面对面模拟 使用口头和非语言对话行为的患者与提供者之间的对话。全面的 目标。这项研究将开发英语和西班牙RA，以传达个性化的预测试遗传 对符合两个癌症的癌症患者的教育 多样化的临床环境（包括低资源，城市，安全网医院和一个大学医学中心 为农村人口提供大量服务）。我们假设使用RA的使用将增加 与通常的护理相比，在启动癌症护理后的90天内接受基因测试结果的患者。目的 1是使用患者驱动的方法来开发英语和西班牙语RA。目标2是进行 RA的多站点随机对照试验进行预测试教育与英语和平常的护理 说西班牙语的患者比较在90天内接受基因测试结果的每个手臂的比例 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，并确定利用促进者和障碍 在这些临床环境中。影响。我们的可交付方式将是多语言的面向患者的RA，以进行预测试 基因教育。该RA将在两个不同的患者人群和诊所中开发和评估 工作流程，可以随着实践的发展而迅速更新，并最终将在互联网上提供诊所 和使用的患者。如果成功，这将是一种提供遗传学的新颖，有效且可扩展的方法 可以改善患者决策准备，知识和满意的教育，最终导致 传统上遗传学不足的患者人群的进入。了解 实施环境并确定促进者和整合RA的障碍将提高可持续性和 概括性。