Patients' and healthcare professionals' experiences with implementing the Rosa chatbot in mainstream genetic testing for hereditary breast and ovarian cancer

Mainstream genetic testing (MGT) refers to genetic testing conducted at the time of a cancer diagnosis without undergoing comprehensive genetic counseling. MGT has been the standard of care for patients with breast or ovarian cancer in Norway for several years. The aim of this study is to explore how newly diagnosed patients with breast or ovarian cancer and healthcare professionals' (HCPs), experience the use of the Rosa chatbot in mainstream genetic testing (MGT) and explore potential barriers to the implementation of chatbots in MGT. We conducted a qualitative study using semi-structured interview guides with selected patients and HCPs. The interviews were done either: in-person, over the digital platform Teams, or over the telephone, depending on the participants' wishes. We chose the Stepwise-Deductive Inductive approach for analyzing the transcripts. Both patients and HCPs viewed the Rosa chatbot positively, describing it as user-friendly, useful, accessible, safe, professional, and trustworthy. They reported that the volume and complexity of information during MGT could be overwhelming and viewed the chatbot as a trustworthy resource for patients to revisit at their own pace, supporting informed decision-making after a positive genetic test result. However, concerns were raised about potential misunderstandings, the impersonal nature of digital communication, and the risk of reduced patient-provider interaction, which together were perceived as an emotional barrier to integrating chatbots into genetic counseling practice.