There is increasing recognition of the important of patient-reported outcomes (PROs) for
assessment of health-related quality of life in both research and clinical settings. PROs
are especially important for inherently subjective but crucial clinical phenomena such as
pain, mood, and fatigue. PROs can also provide valid assessments of health where
performance-based objective measures are possible, but cost prohibitive or complicated.
Despite much research on PROs, concerns about reliability and validity persist,
especially when used at the individual level, particularly among patients who may
struggle to understand PRO questions, such as those with low health literacy.
Over the past decade, the investigators have developed and tested a tool with the
potential to enhance PROs at the individual level - embodied conversational agents (ECA),
which are computer characters that simulate face-to-face conversation using voice, hand
gestures, gaze cues and other nonverbal behavior. The investigators have successfully
used ECAs in behavioral interventions for populations with limited health literacy,
elderly patients, and patients with cancer. Face-to-face encounters, in conjunction with
written instructions supported by pictures, remains one of the best methods for
communicating information in general, but is particularly effective for individuals with
limited health literacy. The investigators have also demonstrated that ECAs can be used
as valid alternatives to standard paper-based surveys for substance use screening, and
that the display of empathy for patients and other relational behavior by ECAs leads to
increased engagement by patients over time.
The goal of this study is to adapt our prior work on ECAs to produce ECA-PRO, a framework
for administering PROs over time using an ECA. ECA-PRO will be used to administer PROs
from the Patient-Reported Outcomes Measurement Information System (PROMIS), as well as
measures from the Common Terminology Criteria for Adverse Events (CTCAE). The plan is to
administer PROMIS measures relevant to cancer including physical functioning, fatigue,
depression, anxiety, and pain interference. This study will test the system in an RCT
with 100 patients receiving chemotherapy and/or radiation therapy for gastrointestinal or
head and neck cancer. Participants will be randomized to provide data for 6 weeks using
ECA-PRO (n=50) versus standard web administration (REDCap) (n=50).
