article · BMC Nursing
A clinical trial in Egypt evaluated whether an interactive educational chatbot called ChemoFreeBot could improve self-care and alleviate chemotherapy side effects among women with breast cancer. One hundred and fifty participants were split into three groups receiving either access to the chatbot, face-to-face education from a nurse, or routine care. Patients using ChemoFreeBot could submit typed questions or keywords at any time to obtain information on symptoms and self-care strategies. Following the intervention, participants using the chatbot reported significantly less frequent, severe, and distressing physical and psychological side effects compared with those receiving nurse-led or routine education. They also achieved higher scores for effective self-care behaviours. The findings demonstrate that providing real-time, tailored digital guidance offers substantial advantages over standardised, single-session information delivery methods, supporting patients to manage their symptoms more effectively at home during chemotherapy treatment.
Chemotherapy side effects can be severe and distressing, yet standard hospital education often leaves patients without adequate guidance once they return home. Providing an accessible digital assistant allows patients to access tailored symptom management advice whenever needed, reducing physical and psychological distress and empowering individuals to manage treatment complications safely and independently.
ChemoFreeBot represents an applied digital health intervention tested directly in a clinical trial with cancer patients. It could serve as a supportive software tool for oncology clinics, healthcare providers, and digital health platforms seeking to supplement nursing staff and automate patient education. Further commercial or clinical deployment would involve integrating the software into existing healthcare communication channels, but its clinical evaluation indicates it is already tested in a target operational environment.
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BACKGROUND: The high levels of unmet needs in relation to provision of self-care information reported by women living with breast cancer suggests that pre-chemotherapy education is suboptimal. Chatbots are emerging as a promising platform to provide education to patients helping them self-manage their symptoms at home. However, evidence from empirical studies on the effect of chatbots education on women living with breast cancer self-care behaviors and symptoms management are scarce. METHODS: This three-arm randomized controlled trial was performed in a chemotherapy day care center within an oncology center in Egypt. A total of 150 women living with breast cancer were randomly selected and randomized into three groups: the ChemoFreeBot group (n = 50), the nurse-led education group (n = 50), and the routine care group (n = 50). In the ChemoFreeBot group, women were given a link to interact with ChemoFreeBot and ask questions about their symptoms and self-care interventions by typing questions or keywords at any time. On the same day as their first day of chemotherapy, the nurse-led education group received face to face teaching sessions from the researcher (nurse) about side effects and self-care interventions. The routine care group received general knowledge during their chemotherapy session about self-care interventions. The self-care behaviors effectiveness and the frequency, severity and distress of chemotherapy side effects were measured at baseline and postintervention for the three groups. The ChemoFreeBot's usability was assessed. RESULTS: The mixed design repeated measures ANOVA analyses revealed a statistically significant both group effect and interaction effect of group*time, indicating a significant difference between the three groups in terms of the physical symptoms frequency (F = 76.075, p < .001, F = 147, p < .001, respectively), severity (F = 96.440, p < .001, F = 220.462, p < .001), and distress (F = 77.171, p < .001, F = 189.680, p < .001); the psychological symptoms frequency (F = 63.198, p < .001, F = 137.908, p < .001), severity (F = 62.137, p < .001), (F = 136.740, p < .001), and distress (F = 43.003, p < .001, F = 168.057, p < .001), and the effectiveness of self-care behaviors (F = 20.134, p < .001, F = 24.252, p < .001, respectively). The Post hoc analysis with Bonferroni adjustment in showed that women in the ChemoFreeBot group experienced a statistically significant less frequent, less severe and less distressing physical and psychological symptoms and higher effective self-care behaviors than those in the nurse-led education and routine care groups (p > .001). CONCLUSION: ChemoFreeBot was a useful and cost-effective tool to improve increase self-care behavior and reduce chemotherapy side effects in women living with breast cancer through the provision of personalized education and the improvement of the accessibility to real-time and high-quality information compared to "one size fits all" approach used by nurses to provide the information. ChemoFreeBot can be an empowering tool to assist nurses to educate women with breast cancer and allow women to take an active role in managing their symptom. TRIAL REGISTRATION: This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Center, Clinical Trials Registry on 26/09/2022; Registration No:R000055389,Trial ID:UMIN000048955.
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DOI: 10.1186/s12912-023-01243-7
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