Patient Perceived Experience of Automated Voice Assistants in Oral Cavity Cancer

OBJECTIVE: Effective communication with humans and automated voice assistants (AVA) is essential for full participation in modern life. Because AVA relies on intelligible speech, individuals with speech impairments, such as those treated for oral cavity cancer (OCC), may face barriers when interacting with AVA. We assessed self-reported communication difficulty in patients treated for OCC related to AVA and humans. STUDY DESIGN: Prospective cross-sectional cohort study. SETTING: Out-patient clinics in two tertiary care centers. METHODS: This study was conducted between July 2024 and March 2025 and included adults (≥18 years) diagnosed with and surgically treated for OCC (experimental group) and those without speech impairments (controls). Participants completed the Speech Communication Experience Survey (SCES), which assessed perceived intelligibility when communicating with familiar partners, strangers, and AVA; and, as reported elsewhere, the Speech Handicap Index (SHI). RESULTS: In total, 159 participants were included (69 OCC, 90 controls). OCC participants were more likely to report that familiar partners, strangers, and AVA "almost always" or "always" had difficulty understanding their speech (P < .05). Free flap reconstruction and maxillectomy were associated with greater reported communication difficulty. AVA usage frequency and overall opinions toward AVA did not significantly differ between groups. CONCLUSION: Patients treated for OCC report significantly greater difficulty being understood by both AVA and human listeners compared to controls. These perceptions may inform peri-operative counseling and guide the development of more inclusive AVA technologies capable of accommodating diverse speakers.