Supporting Families of Children with Cancer: Development and Evaluation of a Virtual Assistant for Social Care

PurposeFamilies of children with cancer face substantial financial, social, and emotional stressors, including unmet health-related social needs (HRSN) and toxic stress, which contribute to disparities. Virtual assistants (VAs) offer a scalable option to screen for HRSN and connect families to resources, but their design and acceptability in pediatric oncology are not well characterized. MethodsA two-phase mixed-methods study was conducted to co-design and evaluate a VA for caregivers of children with cancer. In Phase 1, a community advisory board including healthcare providers and a parent advocate (CAB; N=8) iteratively refined VA content, tone, and interface through three virtual co-design sessions. In Phase 2, caregivers (N=40) completed in-person VA prototype usability sessions that included structured observation, a semi-structured interview, the System Usability Scale (SUS), caregiver satisfaction survey, and a reaction card task. Social drivers of health, rurality, and neighborhood disadvantage were characterized using survey data and geocoded indices. ResultsCAB feedback refined prototype components including community resources, stress management, conversation history, and resource feedback. In Phase 2, usability was high (SUS M=82.6, SD=14.0); 95% of caregivers rated the VA easy to use, good to use, and most reported the VA motivated them to stay engaged with screening and resources. Reaction card responses were predominantly positive (e.g., "accessible," "easy," "useful"). Higher social vulnerability was modestly associated with higher usability scores, while rural and medically underserved caregivers reported lower confidence and more negative desirability attributes. ConclusionThe stakeholder-informed VA to address HRSN and toxic stress in pediatric oncology was feasible, highly usable, and acceptable. Future work should test impact on toxic stress, service uptake, and equity in larger, more diverse and longitudinal studies.