Chatbot Use by Patients Seeking Urogynecologic Consultation: A Randomized Trial

IMPORTANCE: Urogynecology patients increasingly investigate their problems using technology-based resources, yet the effect of artificial intelligence (AI) chatbots on patient decision making remains unclear. OBJECTIVE: The objective of this study was to investigate the effect of the use of an AI chatbot platform on patient decisional conflict during an initial urogynecology visit. STUDY DESIGN: In this institutional review board-approved, single-center randomized trial, patients presenting with prolapse, incontinence, or lower urinary tract symptoms were assigned to 1 of 3 groups: (1) ChatGPT-4o (OpenAI) use before the visit, (2) after the visit, or (3) usual care without chatbot use. English- and Spanish-speaking participants used ChatGPT to ask questions about their primary concern. Demographics, prior information-seeking behavior, and visit details were collected. Surveys administered immediately and at 3 months assessed understanding of diagnosis and treatment, decisional conflict (Decisional Conflict Scale), visit satisfaction, and chatbot satisfaction. Chatbot transcripts were analyzed for readability. RESULTS: Among 125 randomized patients (July 2024-December 2024), attrition at 3 months was 3.2%. Most participants were White (78.2%) with at least a high school education (92.8%), and 98.8% had no prior medical chatbot use. Demographics and diagnoses were similar across groups. Decisional conflict was low and did not differ immediately (P = 0.691) or at 3 months (P = 0.875). Understanding of diagnosis, visit satisfaction, and chatbot satisfaction were similar between groups. By 3 months, home chatbot use was more common in the intervention arms (P = 0.011). Chatbot responses averaged an 11th-12th grade reading level. CONCLUSIONS: Patient use of a chatbot peri-visit did not affect decisional conflict. While increasingly accepted, chatbots may not yet optimally support urogynecologic patient-centered decision making.