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Beilby K, Hammarberg K. ChatGPT: a reliable fertility decision-making tool? Hum Reprod 2024; 39:443-447. [PMID: 38199794 PMCID: PMC10905498 DOI: 10.1093/humrep/dead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
The internet is the primary source of infertility-related information for most people who are experiencing fertility issues. Although no longer shrouded in stigma, the privacy of interacting only with a computer provides a sense of safety when engaging with sensitive content and allows for diverse and geographically dispersed communities to connect and share their experiences. It also provides businesses with a virtual marketplace for their products. The introduction of ChatGPT, a conversational language model developed by OpenAI to understand and generate human-like text in response to user input, in November 2022, and other emerging generative artificial intelligence (AI) language models, has changed and will continue to change the way we interact with large volumes of digital information. When it comes to its application in health information seeking, specifically in relation to fertility in this case, is ChatGPT a friend or foe in helping people make well-informed decisions? Furthermore, if deemed useful, how can we ensure this technology supports fertility-related decision-making? After conducting a study into the quality of the information provided by ChatGPT to people seeking information on fertility, we explore the potential benefits and pitfalls of using generative AI as a tool to support decision-making.
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Affiliation(s)
- Kiri Beilby
- Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Karin Hammarberg
- Global and Women’s Health, School of Public and Health and Preventative Medicine, Monash University, Melbourne, Australia
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Copp T, Pickles K, Smith J, Hersch J, Johansson M, Doust J, McKinn S, Sharma S, Hardiman L, Nickel B. Marketing empowerment: how corporations co-opt feminist narratives to promote non-evidence based health interventions. BMJ 2024; 384:e076710. [PMID: 38355160 DOI: 10.1136/bmj-2023-076710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Tessa Copp
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Kristen Pickles
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Minna Johansson
- Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, Australia
| | - Shannon McKinn
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Sweekriti Sharma
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | | | - Brooke Nickel
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
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Copp T, Thompson R, Hammarberg K, Lensen S, Augustine L, Doust J, Peate M, Cvejic E, Mol BW, Lieberman D, McCaffery KJ. Attitudes, knowledge and practice regarding the anti-müllerian hormone test among general practitioners and reproductive specialists: A cross-sectional study. BJOG 2024. [PMID: 38196321 DOI: 10.1111/1471-0528.17741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/14/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To describe clinicians' attitudes, knowledge and practice relating to the anti-müllerian hormone (AMH) test. DESIGN Cross-sectional nationwide survey. SETTING Australia. POPULATION OR SAMPLE A total of 362 general practitioners (GPs), gynaecologists and reproductive specialists. METHODS Clinicians were recruited through relevant professional organisations, with data collected from May 2021 to April 2022. MAIN OUTCOME MEASURES Clinicians' attitudes, knowledge and practice relating to the AMH test, measured using multiple choice, Likert scales and open-ended items. RESULTS Fifteen percent of GPs (n = 27) and 40% of gynaecologists and other specialists (n = 73) order at least one AMH test per month. Specialists reported raising the idea of testing most of the time, whereas GPs reported that patient request was more common. Half of clinicians lacked confidence interpreting (n = 182, 51%) and explaining (n = 173, 48%) an AMH result to their patients. Five percent (n = 19) believed the test was moderately/very useful in predicting natural conception/birth and 22% (n = 82) believed the same for predicting premature menopause, despite evidence that the test cannot reliably predict either. Forty percent (n = 144) had previously ordered the test to help with reproductive planning and 21% (n = 75) to provide reassurance about fertility. CONCLUSIONS Clinicians reported use of AMH testing in clinical circumstances not supported by the evidence. With the proliferation of direct-to-consumer testing, efforts to support clinicians in the judicious use of testing and effectively navigating patient requests are needed.
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Affiliation(s)
- Tessa Copp
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lidiya Augustine
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Devora Lieberman
- City Fertility Centre Pty Ltd, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
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Shih P, Ding P, Carter SM, Stanaway F, Horvath AR, Langguth D, Saad M, St John A, Bell K. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility. BMJ Open 2023; 13:e074205. [PMID: 38151277 PMCID: PMC10759116 DOI: 10.1136/bmjopen-2023-074205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse. DESIGN Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse. RESULTS We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation. CONCLUSIONS This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.
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Affiliation(s)
- Patti Shih
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Ding
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- NSW Health Pathology, Sydney, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Daman Langguth
- Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Mirette Saad
- Australian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Mahase E. Consumer fertility tests: five minutes with . . . Brooke Nickel. BMJ 2023; 382:1901. [PMID: 37586730 DOI: 10.1136/bmj.p1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Johnson A, Thompson R, Nickel B, Shih P, Hammarberg K, Copp T. Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests. JAMA Netw Open 2023; 6:e2330192. [PMID: 37603332 PMCID: PMC10442712 DOI: 10.1001/jamanetworkopen.2023.30192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Importance The recent provision of direct-to-consumer (DTC) Anti-Mullerian Hormone (AMH) testing in several countries has been contentious, particularly due to concerns about judicious testing and informed consent. Objective To describe and analyze information on websites that sell DTC AMH tests. Design, Setting, and Participants Qualitative study including content analysis of text information from websites in multiple countries that sell AMH tests DTC. The top 50 search results from 4 different internet search strings were captured and reviewed for eligibility. Data were extracted in March 2022 and analyzed from April 2022 to July 2023. Main outcomes and measures Themes and categories were derived from the website content using a conventional inductive approach, with a particular focus on information content, quality and accuracy, as well as the tone and language used. Results Twenty-seven websites across 7 different countries formed the sample for analysis. Information varied considerably across websites and was organized into 6 overarching categories: (1) whether a test description was included (25 websites [93%]); (2) statements about what the test can do, which included indicating ovarian reserve (26 websites [96%]) and indicating likelihood of conceiving (20 websites [74%]); (3) statements about the usefulness of the test result, which included enabling women to adjust their reproductive timeline (11 websites [41%]) and determining whether egg freezing was a viable option (8 websites [30%]); (4) blood collection method (ie, through a laboratory or an at-home sample); (5) promotion tactics, such as stating the convenience of testing (24 websites [89%]) and using language promoting empowerment and control (7 websites [26%]); and (6) statements about limitations of the test, which included polycystic ovary syndrome falsely inflating AMH levels (13 websites [48%]) and that it cannot accurately predict chances of conceiving (9 websites [33%]). Conclusion and relevance In this qualitative study including content analysis, most websites selling DTC AMH tests included false and misleading claims which might lead consumers to purchase an AMH test in the belief that it can reliably predict fertility potential and age of menopause. Depending on the test result, this may in turn lead to misplaced anxiety or reassurance about one's fertility and modifications to subsequent conception or contraceptive plans and behavior.
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Affiliation(s)
- Alexis Johnson
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patti Shih
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tessa Copp
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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