Design and Pilot Implementation of a Chatbot to Support Breast Cancer Screening Among Black Women

Black women are more likely than White women to be diagnosed at later stages and to die from breast cancer. Increasing breast cancer screening rates could help improve early detection of and survival from breast cancer. To this end, this study seeks to implement and evaluate a culturally tailored chatbot intervention to increase breast cancer screening and address inequities among Black women using community-based research approaches. We will conduct a pilot randomized quality improvement trial to test the efficacy of a chatbot outreach intervention, which provides breast cancer screening education and direct links to scheduling, on increasing breast cancer screening completion among Black women who receive primary care at the University of Washington (UW) Medicine. We hypothesize that compared to women who receive usual care, women who receive this novel chatbot outreach will have higher breast cancer screening completion rates at 90-days. In addition to quantitative assessment of chatbot effectiveness, we will also qualitatively evaluate chatbot acceptability, feasibility, and message relevance through interviews with a small group of participants about their experiences with the chatbot.

Inclusion Criteria: * Age 40 through 74 years at the time of eligibility assessment. * Assigned female at birth. * An active UW Medicine primary-care patient and included in the UW Medicine population-health breast cancer screening outreach population. * Due for breast cancer screening, defined as having no documented mammogram within the prior 24 months, based on the UW Medicine adaptation of the NCQA HEDIS breast cancer screening measure. * Have a mobile phone number on file and opted in to receiving text messages from UW Medicine. * Eligible to receive routine breast cancer screening outreach according to UW Medicine clinical and operational criteria. Exclusion Criteria: * History of bilateral mastectomy. * EHR diagnosis or indicator of palliative care, advanced illness, or frailty.