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J Am Med Inform Assoc. 2018 Sep 1;25(9):1248-1258. doi: 10.1093/jamia/ocy072.

Conversational agents in healthcare: a systematic review.

Author information

1
Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.

Abstract

Objective:

Our objective was to review the characteristics, current applications, and evaluation measures of conversational agents with unconstrained natural language input capabilities used for health-related purposes.

Methods:

We searched PubMed, Embase, CINAHL, PsycInfo, and ACM Digital using a predefined search strategy. Studies were included if they focused on consumers or healthcare professionals; involved a conversational agent using any unconstrained natural language input; and reported evaluation measures resulting from user interaction with the system. Studies were screened by independent reviewers and Cohen's kappa measured inter-coder agreement.

Results:

The database search retrieved 1513 citations; 17 articles (14 different conversational agents) met the inclusion criteria. Dialogue management strategies were mostly finite-state and frame-based (6 and 7 conversational agents, respectively); agent-based strategies were present in one type of system. Two studies were randomized controlled trials (RCTs), 1 was cross-sectional, and the remaining were quasi-experimental. Half of the conversational agents supported consumers with health tasks such as self-care. The only RCT evaluating the efficacy of a conversational agent found a significant effect in reducing depression symptoms (effect size dā€‰=ā€‰0.44, pā€‰=ā€‰.04). Patient safety was rarely evaluated in the included studies.

Conclusions:

The use of conversational agents with unconstrained natural language input capabilities for health-related purposes is an emerging field of research, where the few published studies were mainly quasi-experimental, and rarely evaluated efficacy or safety. Future studies would benefit from more robust experimental designs and standardized reporting.

Protocol Registration:

The protocol for this systematic review is registered at PROSPERO with the number CRD42017065917.

PMID:
30010941
PMCID:
PMC6118869
DOI:
10.1093/jamia/ocy072
[Indexed for MEDLINE]
Free PMC Article

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