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

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 t29=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, t29=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.