||1R01CA263532-01A1 Interpret this number
||University Of Southern California
||Increasing Access to Genetic Testing in Underserved Patients Using a Multilingual Conversational Agent
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
If you are accessing this page during weekend or evening hours, the database may currently be offline for maintenance and should operational within a few hours. Otherwise, we have been notified of this error and will be addressing it immediately.
Please contact us
if this error persists.
We apologize for the inconvenience.
- The DCCPS Team.