Where healthcare challenges find solutions


Using avatars to practice hard conversations

The woman sits at a picnic table in an idyllic park with rolling hills behind her, dappled by sunlight shining through the trees.

“I would be happy to answer any questions you might have,” she says. “First off, how are you feeling?”

This woman is not real.

"These conversations with virtual humans educate people and give them the information they need to make the right decisions."
--Ron Goldman

She's a simulation created by the company Kognito to counsel women with triple-negative breast cancer about treatment so they can make informed decisions about whether to get chemotherapy.

The idea of the pilot program, which is funded by the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control, is that patients will be comfortable enough with a simulation—which Kognito calls a “virtual coach”—to ask questions they might otherwise feel too uncomfortable or overwhelmed to ask.

In real life, “a conversation like that is very difficult,” said Kognito CEO Ron Goldman. “In some cases, the patient may not be able to pay attention to the details, considering what they were just told.”

In a simulation, though, “we're giving these women the opportunity to have a very empathetic and private conversation with a virtual coach who can answer all of their questions—and only the questions they care about,” Goldman said. The virtual coach tracks the patient's responses and questions to tailor the conversation and try to appropriately explain the science of the illness and treatment options.

To design the simulation, which debuted at a hospital in Atlanta, Kognito worked with physicians and cancer patients. The company designed the character's look, age and personality.


Kognito, based in New York City, initially thought the coach should look like a celebrity who's battled cancer. But 
real-life patients thought otherwise.

“They said, 'we want someone just like us who went through this and can tell us about the experience,' ” Goldman said. So Kognito came up with Linda, who herself is a cancer survivor.


Headquarters: New York City


Innovation: In Kognito simulations, patients and providers have conversations with avatars to learn more about conditions and how to better interact in person.

Status: A public version of the Centers for Disease Control and Prevention simulation will be available via an app and the web (on the CDC website) in early 2018.

When Delphyne Lomax Taylor was diagnosed with triple-negative breast cancer, she didn't even know what it was. “When you tell someone you're triple-negative, they say, 'Oh, great!' because they think of negative as being good,” she said. (In fact, the virtual coach has that reaction.)

Taylor was one of the patients who advised Kognito, sharing her story and what questions she had during the diagnosis and treatment process.

Unlike the breast cancer simulation, other Kognito modules are designed for providers (as well as people in other industries, such as education). Practice makes perfect, even in talking, and especially in healthcare, where difficult conversations with patients don't necessarily come naturally to providers.

But by using the Kognito simulation platform, providers can try out conversations with avatars before speaking with human patients.

For example, in a simulation about antibiotics and whether they're the correct treatment, users can play the role of either the patient or the clinician. The goal of the clinician is to explain antibiotic use in understandable language and to engage the patient in the treatment plan in an “efficient, fully collaborative conversation.”

The simulations have been successful, Goldman said. In the three months after primary-care providers com-
pleted a simulation that helps them screen for substance-use disorders and intervene if necessary, 41% more patients were screened.

“These conversations with virtual humans educate people and give them the information they need to make the right decisions,” Goldman said. “You learn the skills to really engage in these conversations effectively in real life.”



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