In a study from Huntsman Cancer Institute on the University of Utah (the U) and NYU Langone Perlmutter Cancer Center, researchers found that a specialized chatbot can effectively assist patients in deciding whether to pursue genetic testing, offering an alternative choice to traditional genetic counseling.
Kimberly Kaphingst, ScD, research director of the Genetic Counseling Shared Resource and co-leader of the Cancer Control and Population Sciences Program at Huntsman Cancer Institute, and professor of communication on the U, says the outcomes of the BRIDGE (Broadening the Reach, Impact, and Delivery of Genetic Services) trial could help expand patient access to genetic care.
Based on the American Cancer Society, as much as 10% of all cancers could also be brought on by inherited genetic changes.
“There’s a considerable number of people that have an inherited cancer syndrome. The overwhelming majority don’t comprehend it,” says Kaphingst. “As we’re improving at recognizing people who find themselves in need of genetic testing, we were very interested as a team in coming up with sustainable and scalable ways to really provide those varieties of genetic services.”
The present standard of care model for genetic testing involves a two-appointment process. Patients first meet with a genetic counselor for a pre-test appointment, during which they discuss their family history, in addition to the risks, advantages, and limitations of testing. If patients decide to proceed with testing, they schedule a second appointment to research the outcomes with the counselor.
The BRIDGE trial used an algorithm to seek out patients at higher risk for inherited cancer syndromes based on their self-reported family health histories.
Researchers then divided greater than 3,000 Utah and Latest York participants into two groups — one pursuing the usual two-appointment model, and the opposite engaging with a chatbot designed and scripted to supply genetics education as an alternative of getting a pre-test appointment with a genetic counselor.
Participants within the chatbot group were sent a message through MyChart, a web-based patient health portal, recommending genetic services and providing a link to launch a chatbot. They then received details about genetic testing and were capable of ask inquiries to help them determine in the event that they should proceed with testing.
Researchers found outcomes between the 2 groups were equally more likely to complete genetic testing, demonstrating that a chatbot is a viable alternative to the standard model.
“Our goal wasn’t to see if the chatbot was higher or for worse. The query was, is that this one other model that we are able to use to supply genetic services to patients and have similar outcomes. For quite a lot of people, the chatbot model provided enough information,” says Kaphingst. “The chatbot can take a number of the burden off genetic counselors and help provide genetic testing to more patients who’re eligible.”
Researcher and genetic counselor Rachelle Chambers, MS, CGC, manager of the High-Risk Cancer Genetics Program at NYU Langone Perlmutter Cancer Center, says the promising results of this equivalency trial are crucial as knowledge of and demand for genetic testing is on the rise.
“Twenty years ago, we were testing for a handful of cancer-related genes, like BRCA1 and BRCA2, which may result in an increased risk for breast and ovarian cancer. Now, we would analyze 100 different genes linked to cancers,” says Chambers. “From my perspective as a genetic counselor, there should not enough genetic specialists to satisfy the increased demand of patients that may benefit from one of these testing.”
Patients who know they’re genetically more more likely to develop cancer will be proactive in prevention, through increased screenings, taking medications, pursuing surgery to scale back risk, and changing personal behaviors.
The outcomes of the BRIDGE trial have been published in JAMA Network Open.
The trial was co-led by Saundra Buys, MD, Huntsman Cancer Institute investigator and professor within the department of medication on the U, and Meenakshi Sigireddi, MD, assistant professor of medication at NYU Grossman School of Medicine. Additional Huntsman Cancer Institute collaborators include Wendy Kohlmann, MS, now on the U.S. Department of Veterans Affairs, Sarah Colonna, MD, Whitney F. Espinel, CGC, MS, Amanda Gammon, MS, CGC, Josh Schiffman, MD, professor of pediatrics on the U, Kensaku Kawamoto, MD, PhD, MHS, FACMI, FAMIA, professor of clinical informatics on the U, Guilherme Del Fiol, MD, PhD, FACMI, professor of biomedical informatics on the U, and David Wetter, PhD, MS, professor of population health sciences on the U. Michael Flynn, MD, adjunct assistant professor on the U, and Rachel Hess, MD, MS, professor of population health sciences on the U, also contributed to the study.
This study was supported by the National Institutes of Health/National Cancer Institute through U01CA232826, which was a part of the Inherited Cancer Syndrome Collaborative, P30 CA02014; and Huntsman Cancer Foundation.
