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Cited by 82Cancer survivorship and careMobile Health and mHealth ApplicationsWomen's cancer prevention and management

A nurse versus a chatbot ‒ the effect of an empowerment program on chemotherapy-related side effects and the self-care behaviors of women living with breast Cancer: a randomized controlled trial

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Tawfik, Elham, Ghallab, Eman, Moustafa, Amel·2023·BMC Nursing
DOI 10.1186/s12912-023-01243-7PMC PMC10077642
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Abstract

Background: The high levels of unmet needs in relation to provision of self-care information reported by women living with breast cancer suggests that pre-chemotherapy education is suboptimal. Chatbots are emerging as a promising platform to provide education to patients helping them self-manage their symptoms at home. However, evidence from empirical studies on the effect of chatbots education on women living with breast cancer self-care behaviors and symptoms management are scarce. Methods: This three-arm randomized controlled trial was performed in a chemotherapy day care center within an oncology center in Egypt. A total of 150 women living with breast cancer were randomly selected and randomized into three groups: the ChemoFreeBot group (n = 50), the nurse-led education group (n = 50), and the routine care group (n = 50). In the ChemoFreeBot group, women were given a link to interact with ChemoFreeBot and ask questions about their symptoms and self-care interventions by typing questions or keywords at any time. On the same day as their first day of chemotherapy, the nurse-led education group received face to face teaching sessions from the researcher (nurse) about side effects and self-care interventions. The routine care group received general knowledge during their chemotherapy session about self-care interventions. The self-care behaviors effectiveness and the frequency, severity and distress of chemotherapy side effects were measured at baseline and postintervention for the three groups. The ChemoFreeBot’s usability was assessed. Results: The mixed design repeated measures ANOVA analyses revealed a statistically significant both group effect and interaction effect of group*time, indicating a significant difference between the three groups in terms of the physical symptoms frequency (F = 76.075, p < .001, F = 147, p < .001, respectively), severity (F = 96.440, p < .001, F = 220.462, p < .001), and distress (F = 77.171, p < .001, F = 189.680, p < .001); the psychological symptoms frequency (F = 63.198, p < .001, F = 137.908, p < .001), severity (F = 62.137, p < .001), (F = 136.740, p < .001), and distress (F = 43.003, p < .001, F = 168.057, p < .001), and the effectiveness of self-care behaviors (F = 20.134, p < .001, F = 24.252, p < .001, respectively). The Post hoc analysis with Bonferroni adjustment in showed that women in the ChemoFreeBot group experienced a statistically significant less frequent, less severe and less distressing physical and psychological symptoms and higher effective self-care behaviors than those in the nurse-led education and routine care groups (p > .001). Conclusion: ChemoFreeBot was a useful and cost-effective tool to improve increase self-care behavior and reduce chemotherapy side effects in women living with breast cancer through the provision of personalized education and the improvement of the accessibility to real-time and high-quality information compared to “one size fits all” approach used by nurses to provide the information. ChemoFreeBot can be an empowering tool to assist nurses to educate women with breast cancer and allow women to take an active role in managing their symptom. Trial registration: This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Center, Clinical Trials Registry on 26/09/2022; Registration No:R000055389,Trial ID:UMIN000048955.

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  • Tawfik et al. conducted an RCT proving that CAs could effectively alleviate both physical and psychological symptoms after chemotherapy and promote self-care behaviours.

    “Tawfik et al. conducted an RCT proving that CAs could effectively alleviate both physical and psychological symptoms after chemotherapy and promote self-care behaviours (Tawfik et al. 2023).”

    From The Usability and Experience of Artificial Intelligence‐Based Conversational Agents in Health Education for Cancer Patients: A Scoping Review (2026) · cites this paper as Tawfik et al. 2023

    The Methods describe a three-arm randomized controlled trial, and the Results report less frequent, less severe physical and psychological symptoms and more effective self-care behaviors in the ChemoFreeBot group than in the nurse-led education and routine-care groups. The claim overstates this as proof about conversational agents generally: the trial tested one chatbot in women receiving chemotherapy for breast cancer, and measured the effectiveness of self-care behaviors rather than simply whether those behaviors increased. (LLM, conf=0.86)

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  • Over 90% of patients agreed ChemoFreeBot was easy to use on the Chatbot Usability Questionnaire.

    “Tawfik (Tawfik et al. 2023) used the Chatbot Usability Questionnaire (CUQ), a chatbotspecific usability questionnaire, to evaluate ChemoFreeBot, finding that over 90% of patients agreed it was easy to use.”

    From The Usability and Experience of Artificial Intelligence‐Based Conversational Agents in Health Education for Cancer Patients: A Scoping Review (2026) · cites this paper as Tawfik et al. 2023

  • Only one randomized controlled trial proved that patients with breast cancer in the conversational agent group experienced milder symptoms and more effective self-care behaviours.

    “with only one RCT proving that patients with breast cancer in the CA group experienced milder symptoms and more effective self-care behaviours (Tawfik et al. 2023).”

    From The Usability and Experience of Artificial Intelligence‐Based Conversational Agents in Health Education for Cancer Patients: A Scoping Review (2026) · cites this paper as Tawfik et al. 2023

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Cited by

Sorted by citations

Authors
Tawfik, E., Ghallab, E., & Moustafa, A.
Affiliations
  • British University in Egypt (EG)
  • Galala University (EG)
  • Damanhour University (EG)
Corresponding author
Ghallab, Eman
ORCID
Venue
BMC Nursing
Publisher
Springer Science and Business Media LLC
Published
2023-04-06
Volume
22
Issue
1
Pages
102-102
ISSN
1472-6955 (ISSN-L)
DOI
10.1186/s12912-023-01243-7
PMC
PMC10077642
OpenAlex
W4362667331
Cited by
82
References
7
Citations by year
2026: 33 · 2025: 30 · 2024: 15 · 2023: 4
FWCI
10.00
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Nursing (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Alexandria University
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
breast cancer, chemotherapy side effects, chatbots, self-care behavior, patient education, nurse-led education, symptom management, psychological distress, somatic symptoms, chatbot usability, digital health interventions, women with cancer, empowerment programs, Egypt, Arabic-speaking patients

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