In Tech We Trust? Artificial Intelligence and Prognostication in End of Life and Palliative Care
Saturday, October 14, 2023
10:30 AM – 11:45 AM ET
Location: Heron (Fourth Floor)
Although use of prognostic tools is not new in medicine, artificial intelligence (AI)-based prognostication tools can now predict death more accurately and in real-time without clinicians’ involvement. While these tools can help identify patients who could benefit from palliative care sooner, their use raises ethical concerns.
This qualitative study included 45 semi-structured interviews with palliative care clinicians, caregivers, and patients in a multi-center project on AI-based prognostication. Data were analyzed using grounded theory. Here we present findings focused on trust in patient-clinician relationships.
Clinicians, caregivers and patients shared the idea that transparency in the algorithms’ design and application was essential for trust. Physicians worried that sharing prognoses from AI could disrupt trust in the medical team and raised concerns for accountability. Some, but not all, patients and caregivers desired openness to support shared decision-making at key junctures in patients’ illness journeys. Whereas patients and caregivers anchored on exceptions in accuracy in the algorithm’s prediction, clinicians saw the algorithm’s accuracy as powerfully informing decisions.
Transparency is considered key to trusting relationships in health care, but our findings remind us that transparency comes in degrees. AI algorithms – which may be unknowable “black boxes” – may cause us to rethink what level of transparency is required for trust. To avoid potential conflicts over use of AI in and further palliative care’s holistic goals, differences among patients’ and clinicians’ expectations must be reconciled. Further research should explore practical ways to facilitate this dialogue and develop ethical guardrails for the use of AI prognostication.
Ahmed Alasmar – Center for Bioethics and Humanities – University of Colorado; Mika Hamer, PhD, MPH – Center for Bioethics and Humanities – University of Colorado; Matthew DeCamp, MD, PhD – Associate Professor, Center for Bioethics and Humanities, University of Colorado