Wollney Easton N, Sims Shireen Madani, Ricks-Santi Luisel J, Eddy Elizabeth, Wiesman Daniel, Fisher Carla L
Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA.
BMC Public Health. 2025 Jul 19;25(1):2516. doi: 10.1186/s12889-025-23488-4.
To promote genetic screening among women at risk for hereditary breast and ovarian cancer (HBOC), the American College of Obstetricians and Gynecologists recommends that risk assessment be integrated into practice. Chatbots like the Genetic Information Assistant (Gia®) are increasingly implemented to expand access to hereditary genetic screening. Factors that impact chatbot implementation for HBOC risk screening and women's uptake are not fully realized. To refine implementation strategies prior to full scale implementation, we sought to identify women's perceived facilitators/barriers to adopting Gia screening in a rural population within a large healthcare system in the southern United States.
We recruited both women who agreed to screen using Gia (and then recommended for genetic testing based on National Comprehensive Cancer Network guidelines) as well as women who opted not to do the screen from three Women's Health clinics (OB/GYN) in a northern rural region of Florida. We conducted in-depth, semi-structured interviews with 17 women (nine adopted the screen, eight did not). We conducted a thematic analysis to identify and further define barriers/facilitators to women's uptake of Gia for HBOC cancer risk screening in obstetrics/gynecology care.
Women identified six factors that inhibited and/or facilitated their willingness to use Gia for screening: 1) cancer risk perception, 2) communication with their clinician, 3) feasibility of screening, 4) fiscal and insurance concerns, 5) technology trust/distrust, and 6) previous genetic testing experience. Findings illustrate how each factor functioned as a facilitator and/or barrier in women's uptake (e.g., technology being trusted for accuracy versus concerns for data privacy and security).
While chatbots can extend women's cancer risk screening access, particularly in rural regions and with college-educated women, systems-level (cost) and individual-level factors (perceived risk, misconceptions about repeating genetic testing) should be addressed to promote adoption. Women's interaction with a clinician may be a key implementation strategy for addressing these factors to personalize the screening opportunity and promote their chatbot screening adoption.
为了促进对遗传性乳腺癌和卵巢癌（HBOC）高危女性的基因筛查，美国妇产科医师学会建议将风险评估纳入临床实践。像基因信息助手（Gia®）这样的聊天机器人越来越多地被用于扩大遗传性基因筛查的可及性。影响聊天机器人用于HBOC风险筛查的实施以及女性接受程度的因素尚未完全明确。为了在全面实施之前完善实施策略，我们试图在美国南部一个大型医疗系统的农村地区，确定女性在采用Gia筛查方面所感知到的促进因素/障碍。
我们从佛罗里达州北部农村地区的三家妇女健康诊所（妇产科）招募了同意使用Gia进行筛查的女性（然后根据美国国立综合癌症网络指南推荐进行基因检测）以及选择不进行筛查的女性。我们对17名女性（9名采用了筛查，8名未采用）进行了深入的半结构化访谈。我们进行了主题分析，以确定并进一步界定妇产科护理中女性采用Gia进行HBOC癌症风险筛查的障碍/促进因素。
女性确定了六个抑制和/或促进她们使用Gia进行筛查意愿的因素：1）癌症风险认知，2）与临床医生的沟通，3）筛查的可行性，4）财务和保险问题，5）对技术的信任/不信任，6）既往基因检测经历。研究结果说明了每个因素在女性接受过程中是如何作为促进因素和/或障碍发挥作用的（例如，技术因其准确性而被信任，同时又担心数据隐私和安全）。
虽然聊天机器人可以扩大女性癌症风险筛查的可及性，尤其是在农村地区以及受过大学教育的女性中，但应解决系统层面（成本）和个人层面的因素（感知风险、对重复基因检测的误解）以促进采用。女性与临床医生的互动可能是解决这些因素以个性化筛查机会并促进她们采用聊天机器人筛查的关键实施策略。
