The Clinical Integration of ChatGPT Through an Augmented Patient Encounter in a Real-World Urological Cohort: A Feasibility Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Strengths

1. Real-World Use Case: Early study to test ChatGPT live with actual patients, moving beyond simulations.
2. Multidimensional Evaluation: Uses validated tools and clinician feedback. Evaluates both patient and clinician perceptions, offering a balanced viewpoint. Informed consent—this is crucial for such exploratory AI work.

3. Out comes are clear  & Conclusions given are realistic: Acknowledges ChatGPT’s value. Care Discusses the need for careful integration, especially in consent-related aspects.

4. more relavant to present time : As it aligns with current interest in AI integration in medicine, particularly for patient communication and education.

Weaknesses

1.⁠ ⁠Sample Size : Only 9 patients were evaluated.

• Recommendation: Acknowledge this point in both abstract and discussion. Consider a follow-up with a larger, more diverse sample.

2.⁠ ⁠Selection Bias : Patients were pre-screened, English-speaking, and potentially more tech-literate, which can limit care applicability to different patient populations, especially older or digitally illiterate groups.

• Recommendation: Include discussion on selection bias and its impact on findings.

3.⁠ ⁠⁠Lack of Control Group : careNo comparison with conventional education only or brochure based groups as it limits assessment of relative benefit.

• Recommendation: For future work, include a comparative arm.

4.⁠ ⁠Usefulness is overstated : While stating that ChatGPT helped in risk recall, the study lacks quantitative metrics on patient knowledge gain or retention.

• Recommendation: Include objective pre-post knowledge assessment in future studies.

5.⁠ ⁠Visual Aid Limitation is Undersold : The inability of ChatGPT to present diagrams or video is a major drawback in patient education.

• Recommendation: Discuss how multimodal AI tools (like GPT-4o voice/vision) may address this in future iterations.

Suggested Revisions to Authors

1. Reframe the conclusions with greater caution due to small sample size and artificial prompt standardization.
2. Elaborate on data privacy, especially in the context of LLM interaction with PHI.
3. Explicitly suggest future directions, including: Language adaptability and cultural validation studies.

4. Include more detailed examples of the actual ChatGPT responses and the follow-up discussions to enhance transparency. Care care care care

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

In this article, the authors explored the integration of ChatGPT into the patient education process. However, some aspects require clarification.

1-Why did the authors conduct this study? That is, what exactly is their motivation? The research gap should be identified. These sections should be examined in the introduction.

2- The study of only 9 patients is believed to limit the generalizability of the results. The authors should explain this.

3- Selecting patients based on their order of presentation is thought to increase model bias. Why didn't the authors use random selection?

4-Patients are asked only six predetermined questions. In real-life patient-centered systems, the number of questions is much higher. The authors should expand these sections.

5-Regarding patient satisfaction, the 56% figure may be misleading due to the small number of participants. Furthermore, this figure has not been supported by statistical analysis. This situation requires clarification.

6-The model's lack of information or potential for producing hallucinations has only been discussed theoretically, but not analyzed with specific examples from patient responses. Necessary precautions should be taken and explained to prevent hallucinations.

7-More information should be provided about critical issues such as ethics, data privacy, and the consent process in AI-assisted patient communication. These issues need to be addressed in detail and all necessary permissions must be obtained.

8-Writers should avoid sentences that have the same meaning and are repetitive. The article should be thoroughly proofread, and any repetitive structures removed.

9-The literature should be analyzed through interpretation rather than a result-focused review. A re-examination of the literature is recommended.

10-The conclusion is only seven lines long. It is considered extremely superficial. This section needs to be expanded.

Author Response

Please see the attachment. 

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

1. Only nine patients were analyzed in the study, and they were collected from a single center. This limits the generalizability of the findings to patient groups at other centers.
2. While the abstract states that “nine patients were enrolled,” the Results section states that “ten patients were enrolled, but one patient was excluded from the analysis because he refused to use ChatGPT.” This discrepancy should be clarified.
3. Since no comparison was made with the traditional consent process or another educational tool, it remains unclear whether the increase in understanding can be attributed solely to ChatGPT.
4. PEMAT and DISCERN tools were used for usability and quality assessments; while these tools are valid, they rely on subjective evaluations. Adding objective tests (e.g., knowledge exams) that measure information level would provide stronger evidence of educational benefit.
5. The Flesch Reading Ease score was found to be 30.2. This is suitable only for readers at the university graduate level. Considering the diversity of patient literacy, new prompt strategies using simpler requests (e.g., “explain at the elementary school level”) should be tested, and their effect on facilitating reading should be reported.
6. The use of a temporary chat feature is mentioned. However, a detailed discussion regarding data privacy, patient confidentiality, and institutional compliance is lacking. Compliance with HIPAA/GDPR-like regulations, encryption, and data storage policies should be detailed in this section.
7. The study claims to be the first of its kind in urology in terms of real patient-AI interaction. However, no direct comparison has been made with similar chatbots (Bard, Perplexity, etc.) or non-AI methods. A brief comparative discussion would clarify the study's contribution to the literature.

Comments on the Quality of English Language

The English could be improved to more clearly express the research.

Author Response

Please see the attachment.

Author Response File: Author Response.docx