Lee Junbok, Byun Hwa Kyung, Kim Yong Tae, Shin Jaeyong, Kim Yong Bae
Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2025 May 1;122(1):84-92. doi: 10.1016/j.ijrobp.2024.12.012. Epub 2024 Dec 26.
This study aimed to evaluate the use of chatbot and video education to reduce anxiety in patients with breast cancer undergoing radiation therapy (RT).
This randomized controlled trial included patients with breast cancer scheduled for RT after surgery at an outpatient department of radiation oncology in a cancer center, randomly assigned to 4 groups: (1) video + chatbot, (2) video + paper, (3) paper + chatbot, and (4) paper + paper. In each group, patients received information regarding the treatment process and were frequently asked questions using the designated tool. Patient anxiety was evaluated using the Amsterdam preoperative anxiety and information scale (APAIS), state-trait anxiety inventory (STAI), and linear analog scale assessment (LASA) at 3 points: (1) initial outpatient visit (T0), (2) before the RT course (T1), and (3) after the RT course (T2). The primary endpoint was APAIS, and the secondaries were STAI and LASA. A mixed-model repeated-measures ANOVA was conducted with time as a within-group factor and treatment conditions as a between-group factor.
The final analysis included 145 patients. No significant interaction was observed between groups and time for the APAIS, STAI, or LASA. Although unplanned, analyses were conducted using the age of 50 years as the cutoff, based on a previous systematic review of digital literacy in the medical field. A trend toward reduced APAIS was found among patients aged ≤50 years who used the chatbot (per-protocol subgroup). In the video + chatbot group, the APAIS score decreased from 3.06 (T0) to 1.88 (T2); in contrast, in the paper + paper group, it decreased from 2.42 (T0) to 2.06 (T2). In contrast, no significant interaction was observed in the APAIS of per-protocol patients aged ≥50 years.
Overall, no significant differences were found in the effectiveness of different types of educational media in reducing patients' anxiety. However, for young patients who actively use video or chatbot resources, education through digital media may meaningfully reduce their anxiety during the RT process.
本研究旨在评估使用聊天机器人和视频教育来减轻接受放射治疗（RT）的乳腺癌患者的焦虑。
这项随机对照试验纳入了在癌症中心放射肿瘤学门诊计划接受术后放疗的乳腺癌患者，随机分为4组：（1）视频+聊天机器人，（2）视频+纸质材料，（3）纸质材料+聊天机器人，（4）纸质材料+纸质材料。在每组中，患者接受关于治疗过程的信息，并使用指定工具频繁询问问题。在3个时间点使用阿姆斯特丹术前焦虑和信息量表（APAIS）、状态-特质焦虑量表（STAI）和线性模拟量表评估（LASA）评估患者焦虑：（1）初次门诊就诊（T0），（2）放疗疗程前（T1），（3）放疗疗程后（T2）。主要终点是APAIS，次要终点是STAI和LASA。进行了以时间为组内因素、治疗条件为组间因素的混合模型重复测量方差分析。
最终分析纳入了145例患者。在APAIS、STAI或LASA方面，未观察到组间与时间的显著交互作用。尽管属于非计划情况，但根据之前对医学领域数字素养的系统评价，以50岁为界进行了分析。在使用聊天机器人的≤50岁患者中发现了APAIS降低的趋势（符合方案亚组）。在视频+聊天机器人组中，APAIS评分从3.06（T0）降至1.88（T2）；相比之下，在纸质材料+纸质材料组中，评分从2.42（T0）降至2.06（T2）。相反，在≥50岁的符合方案患者的APAIS中未观察到显著交互作用。
总体而言，不同类型的教育媒体在减轻患者焦虑方面的效果未发现显著差异。然而，对于积极使用视频或聊天机器人资源的年轻患者，通过数字媒体进行教育可能会在放疗过程中显著减轻他们的焦虑。
