{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T01:01:15Z","timestamp":1789434075868,"version":"build-2803163510"},"reference-count":39,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n If a patient with cancer is identified as having a pathogenic variant, at-risk relatives are eligible for genetic testing, known as cascade testing. However, in the United States, the patient is responsible for informing their family members, and only about 30% of these family members are ultimately informed and complete testing. There is a need to train patients with cancer to communicate risk information and motivate their family members to obtain genetic testing.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study evaluates \u201cGRACE,\u201d an online relational agent that trains patients with cancer to talk to their family about cancer risk, including role-play simulations that enable patients to practice communication skills.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A quasi-experimental study was conducted with 30 crowd workers with cancer. Primary measures included 5-point pre-post self-reported intent, importance, comfort, and confidence to share genetic test information with family members, as well as knowledge of cancer genetics (KnowGene), satisfaction with (10-item satisfaction measure), and usability of (SUS) the relational agent system.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Likelihood of sharing genetic test information increased significantly pre-post from 4.43 (SD 1.04) to 4.67 (SD .66), Wilcoxon (Z=2.07,\n P<\/jats:italic>\n =.04). Importance of sharing genetic test information increased significantly pre-post from 4.47 (SD .82) to 4.77 (SD .50), Wilcoxon (Z=2.46,\n P<\/jats:italic>\n =.01). Comfort sharing genetic test information increased pre-post from 4.33 (SD 0.99) to 4.57 (SD 0.90), Wilcoxon (Z=1.811,\n P<\/jats:italic>\n =.07). Confidence to share genetic test information increased significantly pre-post from 4.33 (SD 0.994) to 4.63 (SD 0.765), Wilcoxon (Z=2.23,\n P<\/jats:italic>\n =.03). Knowledge of cancer genetics did not increase significantly (mean 13.27, range 1.911 to 13.7, SD 1.932, paired t\n 29<\/jats:sub>\n =1.245,\n P<\/jats:italic>\n =.22). Participants gave high scores for usability (SUS score=71%) and satisfaction (6.09 SD 0.96 out of 7.0), significantly greater than neutral, t\n 29<\/jats:sub>\n =13.445,\n P<\/jats:italic>\n <.001) with the relational agent system.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n GRACE provides communication skills training and information better enabling patients with cancer to reach out to their families, and our preliminary study indicates a potential for future impact. While results were generally positive, these findings should be interpreted with caution due to limitations in the population included in the pilot, the quasi-experimental design and small sample size. Future development should focus on larger-scale evaluation and in-depth follow-up of family communication dynamics following the use of GRACE.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87623","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:15:07Z","timestamp":1774966507000},"page":"e87623-e87623","source":"Crossref","is-referenced-by-count":1,"title":["Promoting Family Communication for Cascade Cancer Genetic Testing With Relational Agent Role-Play: Quasi-Experimental Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2676-9788","authenticated-orcid":false,"given":"Timothy","family":"Bickmore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0745-5798","authenticated-orcid":false,"given":"Madison","family":"Blain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1433-5915","authenticated-orcid":false,"given":"Meghan","family":"Underhill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70043","article-title":"Cancer statistics, 2026","volume":"76","author":"Siegel","journal-title":"CA Cancer J Clin"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1159\/000133305","article-title":"Population estimates of extended family structure and size","volume":"11","author":"Garceau","journal-title":"Community Genet"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s10689-024-00373-4","article-title":"Cascade genetic testing for hereditary cancer syndromes: a review of barriers and breakthroughs","volume":"23","author":"Levine","journal-title":"Fam Cancer"},{"issue":"4","key":"R4","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1097\/GRF.0000000000000895","article-title":"Uptake of cascade genetic testing for hereditary breast and ovarian cancer: a systematic review and meta-analysis","volume":"67","author":"Ahsan","journal-title":"Clin Obstet Gynecol"},{"issue":"10","key":"R5","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.6004\/jnccn.2023.0051","article-title":"NCCN Guidelines\u00ae Insights: Genetic\/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2024","volume":"21","author":"Daly","journal-title":"J Natl Compr Canc Netw"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.ygyno.2019.01.019","article-title":"A patient-centered mobile health application to motivate use of genetic counseling among women with ovarian cancer: a pilot randomized controlled trial","volume":"153","author":"Vogel","journal-title":"Gynecol Oncol"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/cancer.9210","article-title":"Development of a web-based family intervention for BRCA carriers and their biological relatives: acceptability, feasibility, and usability study","volume":"4","author":"Katapodi","journal-title":"JMIR Cancer"},{"issue":"6","key":"R8","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/codi.12880","article-title":"Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial","volume":"17","author":"Dekker","journal-title":"Colorectal Dis"},{"issue":"6","key":"R9","doi-asserted-by":"publisher","DOI":"10.2196\/26264","article-title":"Using a tailored digital health intervention for family communication and cascade genetic testing in swiss and korean families with hereditary breast and ovarian cancer: protocol for the DIALOGUE study","volume":"10","author":"Kim","journal-title":"JMIR Res Protoc"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1002\/jgc4.1656","article-title":"BRCASHARE \u2014Assessment of an animated digital message for intrafamilial communication of pathogenic variant positive test results: a feasibility study","volume":"32","author":"Aeilts","journal-title":"J Genet Couns"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13040925","article-title":"Interventions facilitating family communication of genetic testing results and cascade screening in hereditary breast\/ovarian cancer or Lynch syndrome: a systematic review and meta-analysis","volume":"13","author":"Baroutsou","journal-title":"Cancers (Basel)"},{"key":"R12","unstructured":"Miller W Rollnick S . 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