AI chatbot tested in end-of-life care strategies 
Doctors from Northeastern University and Boston Medical Center in the US are testing the use of an artificial intelligence (AI) chatbot as part of a palliative care strategy for terminally ill patients. The $1.3m study, which is in the second year of a three-year cycle, has seen about 360 patients with less than a year to live handed computers featuring the chatbot. Different modules embedded within the technology perform medical and social tasks, including monitoring pain medication and offering spiritual counselling. All interactions are monitored by clinical staff and results suggest patients are comfortable asking the chatbot questions.

patients might be more inclined to share their symptoms or ask questions when no other human is present.

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Chatbots are used for a variety of tasks: ordering pizza, getting product suggestions via Facebook Messenger and receiving online customer support. But can they cope with death? A three-year clinical study with financial backing of more than $1 million from the National Institutes of Health is exploring whether a chatbot can help terminally ill, geriatric patients with their end-of-life care. Over the next three years, Northeastern University professor Timothy Bickmore and Boston Medical Center doctor Michael Paasche-Orlow will distribute Microsoft Surface tablets preloaded with a chatbot to about 360 patients who have been told they have less than a year to live. Designed in consultation with experts from Boston Medical Center and programmed by Bickmore and other Northeastern University researchers, the chatbot — which takes the form of a middle-age female digital character — is preloaded with a number of capabilities. These include clinical ones — such as gauging a patient's level of pain and keeping tabs on whether medication is being taken — as well as ones to improve a patient's quality of life. There are modules for talking about stress management and promoting exercise, a social chat feature if patients are just looking for someone to talk to, and even a module for spiritual counseling. What Bickmore and Paasche-Orlow expect is that geriatric patients going through palliative care near the end of their lives will get use out of a tablet-based chatbot, and that having such a service available to hospitals and clinics will be valuable to patients long before they're in hospice care. "Primary-care physicians don't think to call in palliative-care services until patients are incurable, when in fact the patient might have been in pain or could've used some kind of intervention beforehand," said Bickmore, associate dean for research in Northeastern University's College of Computer and Information Science. Today about 90 million Americans live with a serious illness, according to the Center to Advance Palliative Care. This number is expected to double over the next 25 years as the baby boomer generation ages.

It turns out that patients were very happy to talk with a computer about it. They were very explicit in telling us, 'The doctor never asked me about these things.' Michael Paasche-Orlow Boston Medical Center doctor

The interactions patients are having with these chatbots are monitored continuously by nurses, who can activate care if a patient tells the chatbot they're experiencing symptoms. The nurses will also alert a family member if patients are telling the chatbot they're thinking about making end-of-life decisions, like completing a last will and testament. "If a patient rates their nausea or pain a little higher, we ask them if they've taken medicine for that and then try to figure out and troubleshoot that experience," Paasche-Orlow said. "With a lot of these types of things, humans just forget to follow up on them, so there's a lot of lost opportunities to support people in different ways." More from Modern Medicine:

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Scientists invent a pen that detects cancer in 10 seconds For a decade Bickmore and Paasche-Orlow have collaborated on health IT projects that make use of conversational artificial intelligence, or what Bickmore calls relational agents: computer agents designed to simulate face-to-face conversations with other people, as well as pick up on gesticulations, facial expressions and body posture. Their latest endeavor began with a call for technologies that could potentially assist older patients in the last stages of a terminal illness. These would be issued by a number of high-level institutes, such as the NIH, National Institute of Nursing Research, National Cancer Institute and the National Institute on Aging. In the medical world, conversational artificial intelligence elicits a mixed response. It's a potentially transformative technology, and something against which doctors and patients should guard themselves. Research around chatbots being used for mental health patients published in 2016 in the Journal of the American Medical Association demonstrated that some patients are more likely to display true emotions when they think they're talking to a computer, an insight that could lead to further deployment of conversational agents as a means to automate and lower the costs of clinical treatments. But there are risks of "ineffective care and patient harm," as the JAMA research said. In particular, researchers singled out digital voice assistants of the kinds created by large tech companies, like Apple , Google , Microsoft and Samsung . Certainly, those voice assistants are not intended to act as de facto doctors, but the JAMA research found that when people asked their digital voice assistants questions related to their mental health, responses were "inconsistent and sometimes inappropriate." "There's a growing number of chatbots or characters out there that pretend to be a health oracle," Bickmore said. "That's a real setup for safety issues for patients." Users of the tablet-based chatbot in the palliative-care study are prevented from giving open-ended responses. Whenever it's a patient's turn to say something to the chatbot, they're given prompts on the screen, multiple-choice style. "We know exactly what their intent is, and they can't go off topic or talk about something we hadn't considered," Bickmore said.

The palliative care chatbot in use at Northeastern University and Boston Medical Center only allows patients to use multiple choice responses to keep communication focused, and keep it from going off topic. Northeastern University

Now in year two of a five-year project that began in 2016, the chatbot project has received $1.3 million, with more funding contingent on the success of the clinical trial that began this year.

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