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Human-in-the-loop avatar chatbot shows promise in supporting hematopoietic stem cell transplantation patients

Bone Marrow Transplantation volume 59, pages 1323–1325 (2024)Cite this article

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Augmented intelligence (AI) is emerging as a powerful tool in medical diagnostics, decision-support, and administration (e.g., billing and prior authorization) [1]. Recent advancements in large language models (LLMs) and chatbots [2] have created space for patient-facing AI applications that can transform traditional human interactions, enhance patient education, address gaps in care, and overcome communication barriers, like language disparities [3]; however, ethical concerns arise when considering full replacement of human care with AI [4], necessitating a human-in-the-loop approach where AI acts as a supportive tool under clinician oversight [5].

One area where AI can potentially enhance care is allogeneic hematopoietic stem cell transplantation (HCT). HCT is a complex procedure associated with significant physical and psychological distress [6], particularly in the first 30 days post-transplant [7], including delirium, post-traumatic stress, anxiety, depression, and loneliness. This period is often marked by adverse effects from the conditioning regimen, uncertainty about engraftment timing, and the complexities of post-transplant care. While medical teams strive to provide psychosocial support and education, access is limited by human resources. This single-arm pilot study adapted a ‘human-in-the-loop’ (HITL) AI avatar chatbot for patients undergoing HCT, based on HCT team feedback, and evaluated the feasibility and usability of implementing this avatar chatbot for inpatients undergoing reduced-intensity conditioning (RIC) HCT at the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) in Boston, MA (ClinicalTrials.gov Identifier: NCT05600101).

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Data availability

For original data, please contact Gregory_Abel@dfci.harvard.edu.

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Funding

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number 1R44CA236253-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Amar H. Kelkar, Nicholas Groblewski, Dillon Clancy, Sara D. Close, Lauren M. Sullivan, Corey Cutler & Gregory A. Abel

  2. Harvard Medical School, Boston, MA, USA

    Amar H. Kelkar, Corey Cutler & Gregory A. Abel

  3. care.coach Corporation, Millbrae, CA, USA

    Chantal Kerssens, Danielle Sherman-Manhard & Victor Wang

Authors
  1. Amar H. Kelkar
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  2. Chantal Kerssens
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  4. Dillon Clancy
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  5. Sara D. Close
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  8. Corey Cutler
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  9. Victor Wang
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  10. Gregory A. Abel
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Contributions

Conceptualization: AHK, VW, GAA; methodology: AHK, CK, VW, GAA; software: CK, DSM, VW; formal analysis: AHK, NG, DC; investigation: AHK, NG, DC, DSM, GAA; resources: VW, GAA; data curation: AHK, CK, NG, DC, DSM; writing—original draft preparation: AHK, NG; writing—review and editing: AHK, CK, NG, DC, SDC, LMS, DSM, CC, VW, GAA; visualization: AHK, NG, GAA; supervision: VW, GAA; project administration: CK, GAA; funding acquisition: CK, VW. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Gregory A. Abel.

Ethics declarations

Competing interests

CK, DSM, and VW report employment, equity interest, and management/governance positions with care.coach corporation. The remaining authors report no relevant conflicts of interest.

Institutional Review Board Approval

All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the DF/BWCC Office for Human Research Studies (Protocol 22-412).

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Kelkar, A.H., Kerssens, C., Groblewski, N. et al. Human-in-the-loop avatar chatbot shows promise in supporting hematopoietic stem cell transplantation patients. Bone Marrow Transplant 59, 1323–1325 (2024). https://doi.org/10.1038/s41409-024-02334-y

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