Conversational Agent to Improve Guideline Concordant Care for People with Cervical Cancer Screening Abnormalities - PROJECT SUMMARY / ABSTRACT Cervical cancer is almost entirely preventable with appropriate screening and management of abnormal results, yet in the US, over 14,000 individuals were diagnosed with cervical cancer in 2023, and over 4,000 died. Black, Hispanic, and low-income individuals have higher cervical cancer incidence and mortality. Over 20% of those diagnosed with cervical cancer did not receive appropriate diagnosis and treatment after an abnormal result. The FDA approved HPV self-collection, a new form of screening, in May 2024. Self-collection will expand access to screening, but increases by nearly twofold the number of patients requiring immediate follow-up after an abnormal result. Fear of cancer, poor communication, and difficulty scheduling follow-up appointments were key barriers. Embodied Conversational Agents (ECAs) are animated computer characters that simulate face-to-face conversation between a patient and a caregiver, using both verbal and nonverbal conversational behavior, to provide a natural and intuitive computer interface that is accessible to patients of all levels of health and computer literacy. We have successfully developed and evaluated this interface in several clinical trials to motivate health behavior change for a wide range of populations, including a pilot evaluation of an ECA that promotes HPV vaccination for the families of patients with cervical pre-cancer and cancer. In this project we will adapt this technology to produce English and Spanish smartphone ECAs for follow-up of abnormal cervical cancer screening results (ECA-CCSA). The ECA will provide follow-up recommendations and motivational interviewing to patients with abnormal screening test results and will facilitate communication with clinic staff. Follow-up promotion over time can lead to completion of needed testing among those with barriers, and the ECA can conduct repeated conversations with patients both prior to and following clinic visits. We will evaluate ECA-CCSA in a randomized controlled trial for patients aged 21 and older with abnormal screening test results to evaluate ECA-CCSA, comparing usual care (UC) versus usual care plus the ECA (UC + ECA-CCSA). The research team is nationally recognized as leaders in cervical cancer prevention, health literacy, and innovative technologies to improve health. This study will advance our research on the development of easy-to-use technologies to empower patients. This scalable approach has significant potential to increase follow-up after an abnormal screening test result, which is timely as clinical settings are currently adopting HPV self-collection technologies. If successful, our team will promote the ECA-CCSA through national networks for broad implementation and work to adapt ECA-CCSA to other languages and settings.
