An Interactive Narrative Format for Clinical Guidelines

Abstract

Clinical guidelines are standardised documents, which summarise best practice in complex medical situations. Their target audience comprises health professionals, or in some cases patient groups, for whom they constitute important sources of patient education. These documents are characterised by a rich knowledge content, which also relies on a complex, largely implicit background. At the heart of guidelines is a set of recommendations describing expected behaviour throughout specific, evolving contexts. Such complex documents can be challenging to assimilate, in particular their patient education versions. The need to contextualise information and visualise behaviours and their consequences suggests the use of virtual environments, as in serious gaming. However, knowledge representation in serious games are often limited and the overall implementation mainly empirical. On the other hand, interactive narratives technologies have demonstrated their ability to embed complex behavioural knowledge and support principled behaviour responding to dynamic contexts. This is why they support the exploration of complex situations, their rehearsal, and the understanding of expected behaviour through what-if interaction. The narrative perspective also provides better user guidance than a pure simulation system, allowing mixed-initiative access to information. The translation of medical protocols as interactive narratives is faced with a number of knowledge representation challenges, in particular for the representation of non-compli-ance and the consequences of incorrect behaviour. Another technical issue is the need to represent both common sense and domain knowledge, and articulate their representation with the Planning domain that forms the backbone of the interactive narrative. As part of the Open FET project MUSE (FP7-296703), we are developing a proof-of-concept prototype exploring the above aspects, and embedding the logical structure of guidelines into a real-time interactive narrative, which provides a principled simulation of the situations faced by patients, which preserves causal and deontic constraints. This paper describes the knowledge engineering process supporting the development of this prototype, from the analysis of patient guidelines to the use of planning representations supporting the interactive narrative.