Schneider Diana, Liedtke Wenke, Klausen Andrea Diana, Lipprandt Myriam, Funer Florian, Bratan Tanja, Heyen Nils B, Aichinger Heike, Langanke Martin
Department of Emerging Technologies, Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany.
Faculty of Theology, University of Greifswald, Greifswald, Germany.
Digit Health. 2025 May 30;11:20552076251339522. doi: 10.1177/20552076251339522. eCollection 2025 Jan-Dec.
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.
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).
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.
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.
患者正面临医学的数字化转型，但很少有研究探讨患者对基于人工智能的临床决策支持系统（AI-CDSS）的看法。我们的研究通过关注患者的需求和担忧，特别是关于信任、责任和自主决定权，填补了这一研究空白。
这项定性研究于2021年4月至2022年4月期间进行，18名来自德国的患者参与了三个焦点小组（每组5-7人）。向这些小组展示了AI-CDSS的示例（手术、肾病学和家庭通气护理），以讨论其实施过程中的伦理和社会问题。访谈依据库卡茨和雷迪克尔（2022年）的结构化定性内容分析法进行分析。
受访者对AI-CDSS的实施表现出相当大的不确定性。结果凸显了患者将AI-CDSS视为一种支持工具或第二种意见的观点，这可能会挑战长期以来的信任、责任和自主决定权价值观，特别是信任与责任之间的关系可能会发生转变，导致两者都丧失。
研究结果表明，患者认为AI-CDSS的实施对他们自己的决策以及未来的医患关系都是一种挑战。信任、责任和自主决定权作为影响决策的因素发生了转变，这进一步表明了这一点。同时，研究结果表明，患者的观点深受个人对AI-CDSS功能理解的影响。因此，向患者和医疗保健专业人员提供信息以防止犹豫不决非常重要。
