Indecision on the use of artificial intelligence in healthcare - A qualitative study of patient perspectives on trust, responsibility and self-determination using AI-CDSS

Background: Patients are confronted with the digital transformation of medicine, yet there is a paucity of studies that discuss the patient perspective on AI-based clinical decision support systems (AI-CDSS). Our study addresses this research gap by focusing on their needs and concerns, especially regarding trust, responsibility, and self-determination.
Methods: The qualitative study was conducted between April 2021 and April 2022 with 18 patients from Germany to participate in three focus groups (5–7 per group). The groups were presented with AI-CDSS examples (surgery, nephrology, and home-ventilated care) to discuss ethical and social aspects of their implementation. The interviews were analyzed in accordance with the structured qualitative content analysis of Kuckartz and Rädiker (2022).
Results: The interviewees expressed considerable uncertainty regarding the AI-CDSS implementation. The results highlight the patients’ perspective of AI-CDSS as a supportive tool or as a second opinion, which could challenge long-held values of trust, responsibility, and self-determination, particularly the relationship between trust and responsibility may undergo a transformation, leading to a loss of both.
Conclusion: The findings demonstrate that patients perceive the AI-CDSS implementation as a challenge both for their own decision-making and for the future doctor-patient relationship. This is further indicated by the shifts of trust, responsibility, and self-determination as influencing decision-making factors. Concurrently, the findings show that the patients’ perspective is profoundly influenced by the individuals’ comprehension of the functionality of AI-CDSS. It is therefore of importance to provide patients and healthcare professionals with information to prevent indecision.