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

Abstract

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.

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