Talk About Death: End of Life Planning with a Virtual Agent

  • Dina Utami
  • Timothy BickmoreEmail author
  • Asimina Nikolopoulou
  • Michael Paasche-Orlow
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 10498)


For those nearing the end of life, “wellness” must encompass reduction in suffering as well as the promotion of behaviors that mitigate stress and help people prepare for death. We discuss the design of a virtual conversational palliative care coach that works with individuals during their last year of life to help them manage symptoms, reduce stress, identify and address unmet spiritual needs, and support advance care planning. We present the results of an experiment that features the reactions of older adults in discussing these topics with a virtual agent, and note the importance of discussing spiritual needs in the context of end-of-life conversations. We find that all participants are comfortable discussing these topics with an agent, and that their discussion leads to reductions in state and death anxiety, as well as significant increase in intent to create a last will and testament.


Conversational agent Relational agent Spirituality Palliative care 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cassel, C.K., Field, M.J.: Approaching death: improving care at the end of life. National Academies Press (1997)Google Scholar
  2. 2.
    Puchalski, C.M.: Spirituality and the Care of Patients at the End-of-Life: An Essential Component of Care. OMEGA - Journal of Death and Dying 56, 33–46 (2008)CrossRefGoogle Scholar
  3. 3.
    Ring, L., Bickmore, T., Pedrelli, P.: An affectively aware virtual therapist for depression counseling. In: ACM SIGCHI Conference on Human Factors in Computing Systems (CHI) Workshop on Computing and Mental Health (2016)Google Scholar
  4. 4.
    DeVault, D., et al: SimSensei kiosk: a virtual human interviewer for healthcare decision support. AAMAS (2014)Google Scholar
  5. 5.
    Sidner, C., Bickmore, T., Rich, C., Barry, B., Ring, L., Behrooz, M., Shayganfar, M.: Demonstration of an always-on companion for isolated older adults. In: 14th Annual SIGdial Meeting on Discourse and Dialogue (SIGDIAL) (2013)Google Scholar
  6. 6.
    Yan-You, C., Jhing-Fa, W., Po-Chuan, L., Po-Yi, S., Hsin-Chun, T., Da-Yu, K.: Human-robot interaction based on cloud computing infrastructure for senior companion. In: TENCON 2011 - 2011 IEEE Region 10 Conference, pp. 1431–1434 (2011)Google Scholar
  7. 7.
    Lucas, G.M., Gratch, J., King, A., Morency, L.-P.: It’s only a computer: Virtual humans increase willingness to disclose. Computers in Human Behavior 37, 94–100 (2014)CrossRefGoogle Scholar
  8. 8.
    Sterling, R., Zimmerman, J.: Shared moments: opportunities for mobile phones in religious participation. In: Proceedings of the 2007 Conference on Designing for User eXperiences, pp. 2–7. ACM, Chicago (2007)Google Scholar
  9. 9.
    Hlubinka, M., Beaudin, J., Tapia, E.M., An, J.S.: AltarNation: interface design for meditative communities. In: CHI 2002 Extended Abstracts on Human Factors in Computing Systems, pp. 612–613. ACM, Minneapolis (2002)Google Scholar
  10. 10.
    Buie, E., Blythe, M.: Meditations on YouTube. In: Proceedings of the 6th International Conference on Designing Pleasurable Products and Interfaces, pp. 41–50. ACM, Newcastle upon Tyne (2013)Google Scholar
  11. 11.
    Wyche, S.P., Hayes, G.R., Harvel, L.D., Grinter, R.E.: Technology in spiritual formation: an exploratory study of computer mediated religious communications. In: Proceedings of the 2006 20th Anniversary Conference on Computer Supported Cooperative Work, pp. 199–208. ACM, Banff (2006)Google Scholar
  12. 12.
    Buie, E., Blythe, M.: Spirituality: there’s an app for that! (but not a lot of research). In: CHI 2013 Extended Abstracts on Human Factors in Computing Systems, pp. 2315–2324. ACM, Paris (2013)Google Scholar
  13. 13.
    Wyche, S.P., Caine, K.E., Davison, B.K., Patel, S.N., Arteaga, M., Grinter, R.E.: Sacred imagery in techno-spiritual design. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, pp. 55–58. ACM, Boston (2009)Google Scholar
  14. 14.
    Cassell, J., Vilhjálmsson, H.H., Bickmore, T.: BEAT: the behavior expression animation toolkit. In: Prendinger, H., Ishizuka, M. (eds.) Life-Like Characters: Tools, Affective Functions, and Applications, pp. 163–185. Springer, Berlin Heidelberg (2004)CrossRefGoogle Scholar
  15. 15.
    Templer, D.I.: The Construction and Validation of a Death Anxiety Scale. The Journal of General Psychology 82, 165–177 (1970)CrossRefGoogle Scholar
  16. 16.
    McMordie, W.R.: Improving Measurement of Death Anxiety. Psychological Reports 44, 975–980 (1979)CrossRefGoogle Scholar
  17. 17.
    Spielberger, C.D.: StateTrait anxiety inventory. Wiley Online Library (2010)Google Scholar
  18. 18.
    Tracey, T.J., Kokotovic, A.M.: Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology 1, 207–210 (1989)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Dina Utami
    • 1
  • Timothy Bickmore
    • 1
    Email author
  • Asimina Nikolopoulou
    • 1
  • Michael Paasche-Orlow
    • 2
  1. 1.Northeastern UniversityBostonUSA
  2. 2.Boston Medical CenterBostonUSA

Personalised recommendations