At present, we are focusing on educating patients about triple negative breast cancer (TNBC), which represents 10% to 20% of all breast cancer diagnoses.5 Women with this type of cancer have a considerably lower survival rate, compared with women who have other types of breast cancer.6

The most effective treatment for TNBC is chemotherapy,7,8,9 which lowers mortality rates and the likelihood of cancer recurrence. But many women do not end up pursuing chemotherapy, leaving a significant gap in treatment. Our challenge was to create a more engaging, tailored, empathetic experience for those patients to learn about the condition — what it is, the different treatment options, what chemotherapy is, and what its side effects are.

The CDC, in particular the Division of Cancer Prevention and Control and the NACDD turned to us to help address this gap and we collaborated heavily with them.

Project sponsors from the CDC and NACDD connected our team with subject matter experts in the field of oncology, as well as actual TNBC survivors, to build a comprehensive understanding of the challenges faced by both providers and patients at the time of diagnosis and throughout their journey to achieve remission. We created our simulation based on their input.

How does your simulation approach fill the gap?

Patients can be overwhelmed when they receive a diagnosis of cancer. Often, a patient hears the word “cancer” and is unable to take in the remainder of the consultation. Even in the days and weeks after receiving the diagnosis, it remains difficult to absorb information or discuss the diagnosis, even with close family members.

Our innovative solution is to provide patients with an emotionally responsive virtual coach named “Linda,” who can provide patients with a critical outlet to express their true feelings and get clear and accurate information, and to increase their motivation to pursue treatment.

How can a virtual coach provide empathy?

Linda speaks to the real-life experience of a survivor, possesses extensive knowledge of TNBC, and tailors her messages to each patient’s level of knowledge, concerns, and overall motivation.

The virtual human technology that powers Linda has been shown to drive increased levels of engagement, potentially leading to sustained behavior modification. Of course, it was extremely challenging to imbue Linda with the compassion and first-hand experience of an actual breast cancer survivor. Our teams spent dozens of hours in conversation with patient advocates to achieve this unique feat. We dialogued, listened to their stories, and found out all the things they wish they had known at the start of their journey. It was eye-opening to us because actual patients were able to bring input to the table that oncologists or other experts wouldn’t even think about. We then shared their wisdom and input with other patients who would follow their footsteps.

Additionally, we learned how they expressed themselves — their manner, body language, facial expression, tone of voice, and cadence. This was important so that Linda wouldn’t be robotic, merely saying the right things but in a mechanical way. We wanted her to present things in a way that would gain the patient’s trust and demonstrate a level of understanding that only a survivor could possess.

Please tell us more about the virtual coaching experience.

Linda is the fist virtual coach who is able to respond to the emotional and motivational state of a newly diagnosed cancer patient with the wisdom and empathy of a true-life cancer survivor.

We built an immersive experience around Linda’s persona to establish a learning environment that meets the needs of a patient’s individual learning style. And we crafted a setting that created a soothing scene for the conversation that would allow the learner to calm the mind and focus on the information being imparted. Our specially designed motion graphics and animations are timed to the dialogue so that the person’s visual and auditory processing mechanisms are simultaneously engaged. This increases retention and further builds motivation for behavioral change.

Another benefit is that, unlike an actual human being — whether a healthcare professional, friend, or cancer survivor — Linda is available any time, anywhere. And the self-directed format enables each person to engage with the topics in the order and at the pace most meaningful, creating a truly personalized experience. Each patient has her own concerns about the treatment, such as cost, treatment success, length of time, or side effects, so education can’t be a one-size-fits-all process.

I’d like to emphasize that we are not conveying to the patient anything that an oncologist or other healthcare professional wouldn’t communicate. We simply give the patient a coach who is never rushed and can tailor the conversation to the patient’s unique needs, in her own time.

Is this program being implemented yet?

Yes, it is already being used by the CDC as a patient education tool, which is publically available at the CDC Website and also directly. Based on feedback we’ve received from cancer survivors, it has been remarkably successful. And the CDC is concluding a study in a local Atlanta hospital to look at the impact of this simulation on health outcomes, including the willingness of these patients to pursue chemotherapy treatment. We are anticipating study publication at the end of 2019.

This has been a tremendous process for us as a company. It sets the path to show how conversations with virtual humans can be impactful and effective in conducting patient education. We are extending this model into other areas, such mental health, opioid use, and chronic disease.

Link to simulation

Trailer about the app:

References

1.    Marcus C. Strategies for improving the quality of verbal patient and family education: a review of the literature and creation of the EDUCATE model. Health Psychol Behav Med. 2014 Jan 1;2(1):482-495.

2.    Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-9.

3.    Centers for Disease Control and Prevention (CDC). Beyond the Brochure: Alternative Approaches to Effective Health Communication. Available at: https://www.cdc.gov/cancer/nbccedp/pdf/amcbeyon.pdf Accessed: February 20, 2019.

4.    Salo D, Perez C, Lavery R, Malankar A, Borenstein M, Bernstein S. Patient education and the Internet: do patients want us to provide them with medical web sites to learn more about their medical problems? J Emerg Med. 2004 Apr;26(3):293-300.

5.    Johns Hopkins Medicine. Triple negative breast cancer. Available at: https://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/triple_negative_breast_cancer.html. Accessed: February 15, 2019.

6.    Gonçalves H, Guerra MR, Duarte Cintra JR, Fayer VA, Brum IV, Bustamante Teixeira MT. Survival Study of Triple-Negative and Non-Triple-Negative Breast Cancer in a Brazilian Cohort. Clin Med Insights Oncol. 2018;12:1179554918790563. Published 2018 Jul 27.

7.    Wahba HA, El-Hadaad HA. Current approaches in treatment of triple-negative breast cancer. Cancer Biol Med. 2015;12(2):106-16.

8.    Baselga J, Gómez P, Greil R, et al. Randomized phase II study of the anti-epidermal growth factor receptor monoclonal antibody cetuximab with cisplatin versus cisplatin alone in patients with metastatic triple-negative breast cancer. J Clin Oncol. 2013;31(20):2586-92.

9.    Morante Z, Ruiz R, De la Cruz, et al. Impact of the delayed initiation of adjuvant chemotherapy in the outcomes of triple negative breast cancer. Presented at the 2018 San Antonio Breast Cancer Symposium. December 5, 2018. Abstract GS2-05.

This article originally appeared on MPR