Delivering care remotely
UF Health virtual human intervention allows for colorectal cancer screening from home
A new University of Florida Health intervention gives patients who qualify access to colorectal cancer screening information and tests from the comfort of their own homes.
Two recent UF studies in Psycho-Oncology and the Journal on Multimodal User Interfaces examine new ways to effectively reach all patients with a new communication tool using a virtual health assistant, or VHA, to deliver a colorectal cancer screening program.
When the studies began five years ago, COVID-19 wasn’t a factor. Now, as a result of the pandemic, many health care appointments have moved to telemedicine — the use of various digital technologies to help patients connect remotely with their care providers and to even get medications prescribed.
“The ability to deliver medical care remotely or through telehealth is emerging as a way to overcome some barriers that patients face, including travel, time away from work, family responsibilities and cost,” said Thomas George, M.D., FACP, associate director for clinical research at the UF Health Cancer Center and a collaborator on the studies.
Using the researcher’s VHA intervention, patients interact with a diverse group of virtual doctors in a digital replica of a UF Health exam room. The virtual providers ask prompted questions and give patients several response options. Patients receive tailored health care information based on their responses.
When information is tailored, people are more likely to pay attention to it and act on it, said Janice Krieger, Ph.D., co-leader of the UF Health Cancer Center’s Cancer Control and Population Sciences Research Program and principal investigator on the studies.
“We’re able to adapt the prevention information patients are given so it’s different than a brochure where not everything might apply to the patient,” Krieger said. “This intervention is a neat opportunity to make to make high-quality, trustworthy information available to the whole family unit, who’s often involved in in health decision making for patients.”
Since November 2018, any UF Health patient between the ages of 50 and 73 who has not completed a colorectal cancer screening test is sent the VHA-delivered intervention via myUFHealth, a patient portal that allows them to access portions of their medical record from a computer or smart device. Patients receive a link to complete their colorectal screening with a virtual health assistant in English or Spanish on their phone or computer.
“We’re really excited that we were on the forefront of developing these methods that use telemedicine in a unique way to help make patients are aware that they need to be screened,” said Krieger, who is also the director of the UF College of Journalism and Communications’ STEM Translational Communication Center.
Colorectal cancer is the third-leading cause of cancer-related deaths in the United States. The American Cancer Society recommends that people at average risk of colorectal cancer begin regular screenings at age 45. Colorectal cancer screening tests can be done with a sensitive stool-based test or a visual exam.
When patients complete the VHA intervention and are identified as needing a screening test, they receive a follow-up email asking if they would like to order a colorectal cancer screening. Now and post-pandemic, patients can then order a fecal immunochemical test, or FIT, which contains equipment and instructions for taking an at-home stool sample and returning it to a lab for testing.
If the FIT comes back positive, the patient will need to schedule a follow-up colonoscopy. If it comes back negative, the patient has completed their screening for the year. The FIT needs to be done once a year while a regular colonoscopy is recommended every 10 years.
“VHA-delivered interventions can help get important information directly to patients in a culturally sensitive manner, including the reasons to know about or pursue cancer screening tests,” George said.
The program features virtual doctors customized to reach populations of patients who are underrepresented in the health care workforce, such as Black and Hispanic health care workers.
“By creating customized versions of digital doctors, our research team hopes to improve communication and better reach communities underrepresented by health care providers while we simultaneously work at UF and UF Health to improve the diversity of the real-life workforce,” George said.
Studies have shown that patients are more likely to take medical recommendations from providers who look like them. Unfortunately, demographic matching is not always possible in a health care setting.
“While never intended to be a substitute for real-life representation by minorities in the health care workforce, the potential benefits of developing this resource are limitless,” George said. “The resource can serve today as a bridge to improve effective communications with current patients, for normalizing the presence of minority health care providers, for role modeling and giving voice to the next generation of minority trainees and students, and for minimizing or mitigating medical misinformation.”
The studies, funded by the National Cancer Institute, highlight how researchers developed this VHA intervention. Adjustments were made based on feedback from patients and representative communities.
“Involving patients in the development process really allows us to contextualize and incorporate unique aspects of patient experiences and incorporate their perspectives into the intervention,” said Melissa Vilaro, Ph.D., M.P.H., C.P.H., a postdoctoral associate in the STEM Translational Communication Center and lead author on the studies. “These details help facilitate a positive experience when patients interact with the VHA.”
The majority of the patient participants, ranging from ages 50 to 73, preferred middle-aged VHAs. They also found doctors in white coats and a virtual rendering of UF exam rooms to be more credible.
In the next phase of the NCI grant, the multidisciplinary research team — composed of computer scientists, linguist, oncologists, pharmacists, family practice physicians and more — hopes to expand to other health contexts, add more language options and work on a voice-activated component.
“We’re working to address the needs of all UF Health patients, including rural patients who live at a distance from the clinic and patients who prefer health information in Spanish,” Krieger said. “This intervention is designed to make screening quick, easy and affordable so all patients have the opportunity to protect their health.
Other UF collaborators include Benjamin Lok, Ph.D.; François Modave, Ph.D.; Folakemi Odedina, Ph.D.; Peter Carek, M.D., CAQSN, FAAFP, DABF; and Mohan Zalake, a Ph.D. candidate.