How do people talk about death?
Most people don’t — at least not until it’s too late, said Timothy Bickmore, a professor at Northeastern University.
For years, Bickmore has been working with staff at the Boston Medical Center to develop computer systems that can interact with patients like professional providers. During that time, he kept hearing about a common problem: most terminally-ill patients don’t get referred to palliative care until it’s too late, which means they don’t get the chance to talk about important issues such as their wills, healthcare proxies, and funeral plans.
That is why Bickmore and his team decide to develop a virtual palliative care coach, or a “chatbot,” that help those who are at the end their lives prepare for their death, both logistically and emotionally.
“In the U.S., a third of the patients that get referred to palliative care die within the first week after being referred,” Bickmore said. “What we do is to get something in the hands of the patients … perhaps months, instead of just days before they die.”
In a pilot study, Bickmore and his team tested the chatbot with 44 people who are between the age 55 and 82. After interacting with the chatbot, participants said their anxiety towards death decreased, and more of them are ready to complete a last will.
“I already knew about health proxy but the two other things, I never thought about those things,” a 63-year-old participant told researchers afterwards. “The funeral and the will I haven’t thought about … because I’m all about living my life.”
One unique aspect that Bickmore decided to include in the system is spiritual counseling, which is especially an important feature for terminally-ill patients, Bickmore said.
Since most terminally-ill patients who will talk to the chatbot are seniors, Bickmore said the team put a lot of thoughts into making a system that is easy to use for people with different levels of computer literacy.
The tablet-based, touchscreen chatbot, which appears on the screen as an animated healthcare agent, is powered by a 3D game engine. While the chatbot speaks, it also utilizes nonverbal languages such as hand gestures and head nods. All these elements aim to make patients feel as comfortable as possible when they talk to the chatbot, Bickmore said.
Unlike popular artificial assistants like Apple’s Siri and Amazon’s Alexa, the chatbot will strictly follow a script, and patients can only choose from a list of options, Bickmore said.
This design aims to keep the patients safe, Bickmore said. “Alexa and Siri can kill you if you ask the wrong questions,” he added. “We fully constrained what patients can talk about … so that we can fully validate the advice we give them. With Alexa and Siri, you can ask questions they have absolutely no knowledge of, and they can misunderstand you, and give you recommendations regarding your healthcare that can cause great harm.”
While the chatbot helps patients to learn more about death, as it’s moving to a clinical trial, Bickmore said the chatbot is not intended to entirely replace real-person interactions.
Instead, the chatbot offers an easy opportunity for terminally-ill patients to talk about these difficult topics before it is too late. During their interactions with the chatbot, they always have the option to talk to a nurse who is working with the study, while the team also monitors patients’ interactions to see if they need to talk to an expert.
Weihua Li recently graduated from Boston University with a dual degree in journalism and political science. Before joining MedTech Boston as an editorial intern, she edited the school’s independent newspaper, The Daily Free Press, and interned at WAMU and WBUR. When she is not reporting, you can find her at Boston’s newest bubble tea shop, looking for the best boba in town.
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