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Abstract
Purpose: This study aimed to evaluate the use of chatbot and video education to reduce anxiety in patients with breast cancer undergoing radiation therapy (RT).

Methods and materials: This randomized controlled trial included patients with breast cancer scheduled for RT after surgery at an outpatient department of radiation oncology in a cancer center, randomly assigned to 4 groups: (1) video + chatbot, (2) video + paper, (3) paper + chatbot, and (4) paper + paper. In each group, patients received information regarding the treatment process and were frequently asked questions using the designated tool. Patient anxiety was evaluated using the Amsterdam preoperative anxiety and information scale (APAIS), state-trait anxiety inventory (STAI), and linear analog scale assessment (LASA) at 3 points: (1) initial outpatient visit (T0), (2) before the RT course (T1), and (3) after the RT course (T2). The primary endpoint was APAIS, and the secondaries were STAI and LASA. A mixed-model repeated-measures ANOVA was conducted with time as a within-group factor and treatment conditions as a between-group factor.

Results: The final analysis included 145 patients. No significant interaction was observed between groups and time for the APAIS, STAI, or LASA. Although unplanned, analyses were conducted using the age of 50 years as the cutoff, based on a previous systematic review of digital literacy in the medical field. A trend toward reduced APAIS was found among patients aged ≤50 years who used the chatbot (per-protocol subgroup). In the video + chatbot group, the APAIS score decreased from 3.06 (T0) to 1.88 (T2); in contrast, in the paper + paper group, it decreased from 2.42 (T0) to 2.06 (T2). In contrast, no significant interaction was observed in the APAIS of per-protocol patients aged ≥50 years.

Conclusions: Overall, no significant differences were found in the effectiveness of different types of educational media in reducing patients' anxiety. However, for young patients who actively use video or chatbot resources, education through digital media may meaningfully reduce their anxiety during the RT process.

Affiliations

Junbok Lee 1, Hwa Kyung Byun 2, Yong Tae Kim 2, Jaeyong Shin 3, Yong Bae Kim 4
1Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
3Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea. Electronic address: drshin@yuhs.ac.
4Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea. Electronic address: ybkim3@yuhs.ac.