Uptake of Cancer Genetic Services for Chatbot vs Standard-of-Care Delivery Models
Authors: Kimberly A. Kaphingst, Wendy K. Kohlmann, Rachelle Lorenz Chambers, Jemar R. Bather, Melody S. Goodman, Richard L. Bradshaw, Daniel Chavez-Yenter, Sarah V. Colonna, Whitney F. Espinel, Jessica N. Everett, Michael Flynn, Amanda Gammon, Adrian Harris, Rachel Hess, Lauren Kaiser-Jackson, Sang Lee, Rachel Monahan, Joshua D. Schiffman, Molly Volkmar, David W. Wetter, Lingzi Zhong, Devin M. Mann, Ophira Ginsburg, Meenakshi Sigireddi, Kensaku Kawamoto, Guilherme Del Fiol, Saundra S. Buys
Journal: JAMA Network Open (2024)

Importance Increasing numbers of unaffected individuals could benefit from genetic evaluation for inherited cancer susceptibility. Automated conversational agents (ie, chatbots) are being developed for cancer genetics contexts; however, randomized comparisons with standard of care (SOC) are needed. Objective To examine whether chatbot and SOC approaches are equivalent in completion of pretest cancer genetic services and genetic testing. Design, Setting, and Participants This equivalence trial (Broadening the Reach, Impact, and Delivery of Genetic Services [BRIDGE] randomized clinical trial) was conducted between August 15, 2020, and August 31, 2023, at 2 US health care systems (University of Utah Health and NYU Langone Health). Participants were aged 25 to 60 years, had had a primary care visit in the previous 3 years, were eligible for cancer genetic evaluation, were English or Spanish speaking, had no prior cancer diagnosis other than nonmelanoma skin cancer, had no prior cancer genetic counseling or testing, and had an electronic patient portal account. Intervention Participants were randomized 1:1 at the patient level to the study groups at each site. In the chatbot intervention group, patients were invited in a patient portal outreach message to complete a pretest genetics education chat. In the enhanced SOC control group, patients were invited to complete an SOC pretest appointment with a certified genetic counselor. Main Outcomes and Measures Primary outcomes were completion of pretest cancer genetic services (ie, pretest genetics education chat or pretest genetic counseling appointment) and completion of genetic testing. Equivalence hypothesis testing was used to compare the study groups. Results This study included 3073 patients (1554 in the chatbot group and 1519 in the enhanced SOC control group). Their mean (SD) age at outreach was 43.8 (9.9) years, and most (2233 of 3063 [72.9%]) were women. A total of 204 patients (7.3%) were Black, 317 (11.4%) were Latinx, and 2094 (75.0%) were White. The estimated percentage point difference for completion of pretest cancer genetic services between groups was 2.0 (95% CI, −1.1 to 5.0). The estimated percentage point difference for completion of genetic testing was −1.3 (95% CI, −3.7 to 1.1). Analyses suggested equivalence in the primary outcomes. Conclusions and Relevance The findings of the BRIDGE equivalence trial support the use of chatbot approaches to offer cancer genetic services. Chatbot tools can be a key component of sustainable and scalable population health management strategies to enhance access to cancer genetic services. Trial Registration ClinicalTrials.gov Identifier: NCT03985852