Promoting Family Communication for Cascade Cancer Genetic Testing With Relational Agent Role-Play: Quasi-Experimental Study

Abstract Background If a patient with cancer is identified as having a pathogenic variant, at-risk relatives are eligible for genetic testing, known as cascade testing. However, in the United States, the patient is responsible for informing their family members, and only about 30% of these family members are ultimately informed and complete testing. There is a need to train patients with cancer to communicate risk information and motivate their family members to obtain genetic testing. Objective This study evaluates “GRACE,” an online relational agent that trains patients with cancer to talk to their family about cancer risk, including role-play simulations that enable patients to practice communication skills. Methods A quasi-experimental study was conducted with 30 crowd workers with cancer. Primary measures included 5-point pre-post self-reported intent, importance, comfort, and confidence to share genetic test information with family members, as well as knowledge of cancer genetics (KnowGene), satisfaction with (10-item satisfaction measure), and usability of (SUS) the relational agent system. Results Likelihood of sharing genetic test information increased significantly pre-post from 4.43 (SD 1.04) to 4.67 (SD .66), Wilcoxon (Z=2.07, P =.04). Importance of sharing genetic test information increased significantly pre-post from 4.47 (SD .82) to 4.77 (SD .50), Wilcoxon (Z=2.46, P =.01). Comfort sharing genetic test information increased pre-post from 4.33 (SD 0.99) to 4.57 (SD 0.90), Wilcoxon (Z=1.811, P =.07). Confidence to share genetic test information increased significantly pre-post from 4.33 (SD 0.994) to 4.63 (SD 0.765), Wilcoxon (Z=2.23, P =.03). Knowledge of cancer genetics did not increase significantly (mean 13.27, range 1.911 to 13.7, SD 1.932, paired t 29 =1.245, P =.22). Participants gave high scores for usability (SUS score=71%) and satisfaction (6.09 SD 0.96 out of 7.0), significantly greater than neutral, t 29 =13.445, P <.001) with the relational agent system. Conclusions GRACE provides communication skills training and information better enabling patients with cancer to reach out to their families, and our preliminary study indicates a potential for future impact. While results were generally positive, these findings should be interpreted with caution due to limitations in the population included in the pilot, the quasi-experimental design and small sample size. Future development should focus on larger-scale evaluation and in-depth follow-up of family communication dynamics following the use of GRACE.