Understanding genetic breast cancer risk: Processing loci of the BRCA Gist Intelligent Tutoring System

Abstract

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one’s own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

The effectiveness of argumentation in tutorial dialogues with an Intelligent Tutoring System for genetic risk of breast cancer

“…There is also clear evidence that the BRCA Gist tutorial dialogues, which focus on self-explanation in the form of gist explanations, lead to appreciable learning gains (Widmer et al, 2015; Wolfe et al, under review). The results of this fine grained analysis of BRCA Gist ’s argumentation dialogues indicates that most participants did not produce arguments when prompted to do so.…”

“…The impact of including argument generation within an Intelligent Tutoring System (ITS) has received little research attention. Furthermore, the use of argumentation to facilitate gist understanding that would aid in patient medical decision making has only recently been explored as a component of studies conducted by Wolfe and colleagues (Wolfe, Reyna, Brust-Renck, et al, 2013; Wolfe, Reyna, Widmer, et al, 2013; Wolfe, et al, under review; Wolfe et al, 2015). BRCA Gist (Breast Cancer and Genetics Intelligent Semantic Tutoring) appears to be the first ITS applied to lay people’s medical decision making (Wolfe et al, 2015).…”

“…More recently, Goldman and colleagues (Goldman, Braasch, Wiley, Graesser, & Brodowinska, 2012) compared better and poorer learners on understanding information they read on-line and found that argumentation instructions were themselves not predictive of outcomes but that better learners engaged in more comprehension-monitoring and self-explanation on reliable websites as compared with unreliable websites. Part of the research conducted by Wolfe and colleagues (under review) compared an argument-interaction and no argument-interaction condition along with self-explanation and no self-explanation conditions in interactions with BRCA Gist . They found that randomly assigning participants to generate arguments did not help improve declarative knowledge, gist comprehension, or risk assessment ability, whereas asking participants to develop gist explanations was associated with significant improvements in key outcomes.…”

On Judgments of Approximately Equal

“…First, approximately equal judgments should play a role in medical decision making (as when a person estimates her cancer risk in considering different courses of action). Second, previous research provides us with a number of reliable and valid instruments for assessing participant's understanding of breast cancer (Widmer et al, ; Wolfe et al, ; Cedillos‐Whynott et al, ; Wolfe, Reyna, Widmer, Brust‐Renck et al, ). Finally, a number of reputable sources such as the National Cancer Institute (NCI) provide reliable statistics on breast cancer and some indications about whether some statistics are roughly the same or approximately equal, as when they suggest that the rate of breast cancer was “unchanged” from 1 year to another even though the statistics were not identical.…”

Tutorial dialogues and gist explanations of genetic breast cancer risk

“…The five questions used in the gist explanation dialogues are BWhat is breast cancer?,^BHow does breast cancer spread?,^BHow do genes affect breast cancer risk?,B ehav Res (2015) 47:632-648BWhat should someone do with a positive test result?,^and BWhat should someone do with a negative test result?^BRCA Gist also includes two argument-based dialogues (BWhat is the case for genetic testing?^and BWhat is the case against genetic testing?^) that differ from the gist explanations that are the focus of this article. An analysis of the argumentation component of BRCA Gist and the use of argumentation in ITS can be found in Cedillos-Whynott, Wolfe, Widmer, Brust-Renck, and Reyna (2015).…”