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.2018 Sep 1;25(9):1248-1258.
doi: 10.1093/jamia/ocy072.

Conversational agents in healthcare: a systematic review

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Conversational agents in healthcare: a systematic review

Liliana Laranjo et al. J Am Med Inform Assoc..

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 d = 0.44, p = .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.

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Figures

Figure 1.
Figure 1.
Flow diagram of included studies in which 17 studies (14 conversational agents) were identified from 1513 articles in the initial database search (April 2017). Search updates were conducted until February 2018, with 3 new papers being identified for full-text screening.
Figure 2.
Figure 2.
Characteristics of included conversational agents in terms of task-orientation, dialogue management, and dialogue initiative.
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