A study on BReast cancer patient care using chAtbot and Video Education for radiation therapy (BRAVE): A randomized controlled trial

Purpose: This study aimed to evaluate the use of chatbot and video education to reduce anxiety in patients with breast cancer undergoing 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 four 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 three 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 secondary was 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 age 50 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 under 50 who utilized 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.

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.