A Randomized Trial Comparing the Effectiveness of Pre-test Genetic Counseling Using an Artificial Intelligence Automated Chatbot and Traditional In-person Genetic Counseling in Women Newly Diagnosed with Breast Cancer
Abstract
Background Alternative service delivery models are critically needed to address the increasing demand for genetics services and limited supply of genetics experts available to provide pre-test counseling. Methods We conducted a prospective randomized controlled trial of women with stage 0-III breast cancer not meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing. Patients were randomized to pre-test counseling with a Chatbot or a certified genetic counselor (GC). Participants completed a questionnaire assessing their knowledge of breast cancer genetics and a survey assessing satisfaction with their decision regarding pre-test counseling. Results A total of 39 patients were enrolled and 37 were randomized to genetic counseling with an automated Chatbot or a GC; 19 were randomized to Chatbot and 18 to traditional genetic counseling, and 13 (38.2%) had a family member with breast cancer but did not meet NCCN criteria. All patients opted to undergo genetic testing. Testing revealed six pathogenic variants in five patients (13.5%): CHEK2 (n = 2), MSH3 (n = 1), MUTYH (n = 1), and BRCA1 and HOXB13 (n = 1). No patients had a delay in time-to-treatment due to genetic testing turnaround time, nor did any patients undergo additional risk reducing surgery. There was no significant difference in median knowledge score between Chatbot and traditional counseling (11 vs. 12, p = 0.09) or in median patient satisfaction score (30 vs. 30, p = 0.19). Conclusion Satis…
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CAs increased knowledge.
“In addition to physical and emotional benefits, another significant support by CAs was increased knowledge (Al-Hilli et al. 2023;Goertz 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 Al-Hilli et al. 2023
Pretest genetic counselling did not affect patients' pre-determined surgical decisions.
“Al-Hilli et al. found there was no significant difference in the improvement of patient knowledge between CAs and professional genetic counselling, and pretest genetic counselling did not affect patients' pre-determined surgical decisions (Al-Hilli 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 Al-Hilli et al. 2023
Al-Hilli et al. found there was no significant difference in the improvement of patient knowledge between CAs and professional genetic counselling.
“Al-Hilli et al. found there was no significant difference in the improvement of patient knowledge between CAs and professional genetic counselling, and pretest genetic counselling did not affect patients' pre-determined surgical decisions (Al-Hilli 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 Al-Hilli et al. 2023
Most included studies demonstrated the non-inferiority of conversational agents.
“While most studies demonstrated the non-inferiority of CAs (Al-Hilli et al. 2023;Bibault, Chaix, Guillemassé, et al. 2019)”
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 Al-Hilli et al. 2023
Cites
CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials
Schulz, K. F., Altman, D. G., & Moher, D. (2010) · Journal of Pharmacology and Pharmacotherapeutics · doi:10.4103/0976-500x.72352 · Cited by 2,165 · see citing works
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Han, R., Acosta, J. N., Shakeri, Z., Ioannidis, J. P. A., Topol, E. J., & Rajpurkar, P. (2024) · The Lancet Digital Health · doi:10.1016/s2589-7500(24)00047-5 · Cited by 336 · see citing works
Roles, Users, Benefits, and Limitations of Chatbots in Health Care: Rapid Review (Preprint)
Laymouna, M., Ma, Y., Lessard, D., Schuster, T., Engler, K., & Lebouché, B. (2024) · doi:10.2196/preprints.56930 · Cited by 302 · see citing works
Li, K., Wu, S., Zhang, Y., Zhu, B., Qi, Z., Hou, S., & Wang, W. (2026) · Journal of Clinical Nursing · doi:10.1111/jocn.70020 · Cited by 10 · see citing works
- Authors
- Al-Hilli, Z., Noss, R., Dickard, J., Wei, W., Chichura, A., Wu, V., Renicker, K., Pederson, H. J., & Eng, C.
- Affiliations
- Cleveland Clinic (US)
- Venue
- Annals of Surgical Oncology
- Published
- 2023-08-11
- Volume
- 30
- Issue
- 10
- Pages
- 5990-5996
- ISSN
- 1068-9265 (ISSN-L)
- 1534-4681
- OpenAlex
- W4385759496
- Cited by
- 63
- References
- 1
- Citations by year
- 2026: 19 · 2025: 23 · 2024: 18 · 2023: 3
- FWCI
- 10.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Annals of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- AI chatbots, breast cancer, hereditary breast cancer, genetic testing, patient satisfaction, pathogenic variants, BRCA1, CHEK2, NCCN criteria, prophylactic surgery
- MeSH terms
- Artificial Intelligence, Breast Neoplasms, Female, Genetic Counseling, Genetic Testing, Humans, Prospective Studies
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