Purpose: To test the efficacy of an expanded version of the BRCA Gist Intelligent Tutoring System (ITS) designed to help women understand and make decisions about genetic testing for breast-cancer risk with a broader range of participants recruited on the web, in local communities, and at two universities.
Methods: This interactive tutorial guided by Fuzzy-Trace Theory is the first use of an ITS in patients' medical decision-making. Three female avatars of varying ethnicities present tutorial information orally, visually, in brief video clips, and in writing (a screen shot is shown below). Tutorial dialogues address questions such as, "how do genes affect breast cancer risk?" Expanded content addresses inherited genetic mutations, what should be considered before genetic testing, how breast cancer spreads, stages of breast cancer, and the Gail model. Using "expectations texts" and Latent Semantic Analysis, a conversational agent (avatar) "understands" and responds to participants' typed questions and comments using natural language. Information pertaining to breast cancer and genetic risk was taken from the National Cancer Institute (NCI) web site, and vetted by medical experts.
The efficacy of the BRCA Gist ITS was tested in two randomized, controlled experiments equating time on task. Participants in both a laboratory experiment (n=210) and a field experiment (n=180) were randomly assigned to one of three conditions: BRCA Gist; studying pages from the NCI web site covering comparable materials; or a control tutorial on nutrition. Participants were then given a test of content knowledge about breast cancer and genetic risk, twelve scenarios applying their knowledge about assessing breast cancer risk, a gist comprehension measure, and questions about the participant's interest in being tested.
Results: In both the laboratory and field experiments, the BRCA Gist group performed significantly better than the control group on content knowledge about breast cancer and genetic risk, gist comprehension, knowledge application, and risk assessment. Participants' interest in testing was significantly lower following the BRCA Gist tutorial. Effect sizes were generally large.
Conclusions: The BRCA Gist ITS may be fruitfully applied in assisting laypeople in preventive health and medical decision-making by effectively teaching content knowledge, enhancing gist-based comprehension, and increasing the ability to apply knowledge to assess risk and make testing decisions about genetics and breast-cancer.
See more of: The 35th Annual Meeting of the Society for Medical Decision Making