Employing Conversational Agents in Palliative Care: A Feasibility Study and Preliminary Assessment

Recording of patient-reported outcomes (PROs) enables direct measurement of the experiences of patients with chronic conditions, including cancer; thus, PROs are a critical element of high quality, person-centered care for cancer patients. A growing body of literature reports on the feasibility of using electronic tools for the collection of Patient reported Outcomes (ePROs), although the usability of available solutions does affect their acceptance and use. In parallel, recent advancement in artificial intelligence, machine learning and speech recognition have led to the growing interest in conversational agents, i.e. software applications that mimic written or spoken human speech. In the present manuscript we provide a review of current developments regarding the implementation of conversational agents and their application in the domain of palliative care for oncology patients and also present (i) a methodology for the implementation of a conversational agent able to collect ePRO health data and (ii) initial evaluation results from a relevant feasibility study. Our approach differs from other available systems since the conversational agent reported in the present work is not based on rules, but rather uses machine learning algorithms and more specifically recurrent neural networks (RNN) for identifying appropriate answers. Evaluation results of user experience provided promising results and highlight that users gave positive responds when interacting with the system. Based on the User Experience Questionnaire, pragmatic quality and overall quality were categorized as excellent and hedonic quality was categorized as good. The result of this research can be used as reference for the future development and improvement of the conversational agents in the healthcare domain.

[1]  Joanne Greenhalgh,et al.  Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations , 2012, Quality of Life Research.

[2]  R. Crutzen,et al.  An artificially intelligent chat agent that answers adolescents' questions related to sex, drugs, and alcohol: an exploratory study. , 2011, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[3]  Toni Giorgino,et al.  Automated Spoken Dialog System for Home Care and Data Acquisition from Chronic Patients , 2003, MIE.

[4]  Joelle Pineau,et al.  MACA: A Modular Architecture for Conversational Agents , 2017, SIGDIAL Conference.

[5]  David Griol,et al.  The Conversational Interface: Talking to Smart Devices , 2016 .

[6]  Satoshi Nakamura,et al.  Embodied conversational agents for multimodal automated social skills training in people with autism spectrum disorders , 2017, PloS one.

[7]  B. Löwe,et al.  Psychometric analysis of the Generalized Anxiety Disorder scale (GAD-7) in primary care using modern item response theory , 2017, PloS one.

[8]  Harry Budi Santoso,et al.  Measuring User Experience of the Student-Centered e-Learning Environment , 2016 .

[9]  Binhuan Wang,et al.  Emergency Department-Initiated Palliative Care in Advanced Cancer: A Randomized Clinical Trial. , 2016, JAMA oncology.

[10]  C. Sidner,et al.  Automated interventions for multiple health behaviors using conversational agents. , 2013, Patient education and counseling.

[11]  Etienne de Sevin,et al.  Virtual human as a new diagnostic tool, a proof of concept study in the field of major depressive disorders , 2017, Scientific Reports.

[12]  Michael Hoerger,et al.  Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  D. Osoba,et al.  The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. , 1993, Journal of the National Cancer Institute.

[14]  K. Fitzpatrick,et al.  Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial , 2017, JMIR mental health.

[15]  Rosalind W. Picard,et al.  Establishing the computer-patient working alliance in automated health behavior change interventions. , 2005, Patient education and counseling.

[16]  Martin Schrepp,et al.  Design and Evaluation of a Short Version of the User Experience Questionnaire (UEQ-S) , 2017, Int. J. Interact. Multim. Artif. Intell..

[17]  Michael Koller,et al.  EORTC QLQ–C30 Reference Values Manual , 1998 .

[18]  Michael F. McTear,et al.  Automated Phone Capture of Diabetes Patients Readings with Consultant Monitoring via the Web , 2008, 15th Annual IEEE International Conference and Workshop on the Engineering of Computer Based Systems (ecbs 2008).

[19]  Albert A. Rizzo,et al.  Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers , 2017, Front. Robot. AI.

[20]  Oren Etzioni,et al.  Artificial intelligence and life in 2030: the one hundred year study on artificial intelligence , 2016 .

[21]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[22]  Manolis Tsiknakis,et al.  Semantic biomedical resource discovery: a Natural Language Processing framework , 2015, BMC Medical Informatics and Decision Making.

[23]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[24]  E. Hudlicka Virtual training and coaching of health behavior: example from mindfulness meditation training. , 2013, Patient education and counseling.

[25]  C. Cleeland,et al.  Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases , 1983, Pain.

[26]  Patricia Michelle Troxell Klingenbjerg Smartphone-Based Conversational Agents and Responses to Questions about Mental Health, Interpersonal Violence, and Physical Health , 2016 .

[27]  Deborah Schrag,et al.  Feasibility of long-term patient self-reporting of toxicities from home via the Internet during routine chemotherapy. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[28]  John Fox,et al.  Automatic generation of spoken dialogue from medical plans and ontologies , 2006, J. Biomed. Informatics.

[29]  Janet Wiles,et al.  Hello Harlie: Enabling Speech Monitoring Through Chat-Bot Conversations , 2016, HIC.

[30]  David Cella,et al.  A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment , 2013, Supportive Care in Cancer.

[31]  Morgan C. Benton,et al.  Evaluating Quality of Chatbots and Intelligent Conversational Agents , 2017, ArXiv.

[32]  Jack Chen,et al.  A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting , 2013, BMC Health Services Research.

[33]  Jérôme Olive,et al.  Could a Virtual Human Be Used to Explore Excessive Daytime Sleepiness in Patients? , 2014, PRESENCE: Teleoperators and Virtual Environments.

[34]  M Tubiana,et al.  The European Organization for Research and Treatment of Cancer (EORTC). , 1988, International journal of radiation oncology, biology, physics.

[35]  David Griol,et al.  AN AUTOMATIC DIALOG SIMULATION TECHNIQUE TO DEVELOP AND EVALUATE INTERACTIVE CONVERSATIONAL AGENTS , 2013, Appl. Artif. Intell..

[36]  Amy P. Abernethy,et al.  Patient-reported outcomes in cancer care — hearing the patient voice at greater volume , 2017, Nature Reviews Clinical Oncology.

[37]  Martin Schrepp,et al.  Construction of a Benchmark for the User Experience Questionnaire (UEQ) , 2017, Int. J. Interact. Multim. Artif. Intell..

[38]  E. Levin,et al.  Evaluation of Spoken Dialogue Technology for Real-Time Health Data Collection , 2006, Journal of medical Internet research.

[39]  Michael F. McTear,et al.  Appraisal of a conversational artefact and its utility in remote patient monitoring , 2005, 18th IEEE Symposium on Computer-Based Medical Systems (CBMS'05).

[40]  Maria Klara Wolters,et al.  Designing a spoken dialogue interface to an intelligent cognitive assistant for people with dementia , 2016, Health Informatics J..

[41]  James F. Allen,et al.  Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study , 2014, Patient preference and adherence.

[42]  Charles W Hoge,et al.  Psychological screening procedures for deploying U.S. Forces. , 2005, Military medicine.

[43]  Toni Giorgino,et al.  Automated Spoken Dialog System for Hypertensive Patient Home Management , 2004 .

[44]  T. Bickmore,et al.  A Randomized Controlled Trial of an Automated Exercise Coach for Older Adults , 2013, Journal of the American Geriatrics Society.

[45]  Xin Geng,et al.  Incremental Learning , 2009, Encyclopedia of Biometrics.

[46]  Jessica A. Chen,et al.  Conversational agents in healthcare: a systematic review , 2018, J. Am. Medical Informatics Assoc..

[47]  Amy P Abernethy,et al.  Review of electronic patient-reported outcomes systems used in cancer clinical care. , 2014, Journal of oncology practice.

[48]  George Potamias,et al.  Mining XML Clinical Data: the HealthObs System , 2005, Ingénierie des Systèmes d Inf..

[49]  Marti A. Hearst,et al.  SVMs—a practical consequence of learning theory , 1998 .

[50]  Marc Hassenzahl,et al.  The Effect of Perceived Hedonic Quality on Product Appealingness , 2001, Int. J. Hum. Comput. Interact..

[51]  Paul McCrone,et al.  The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer , 2017, BMJ Open.