Patient Perspectives on the Use of Artificial Intelligence for Skin Cancer Screening A Qualitative Study
Patient Perspectives on the Use of Artificial Intelligence for Skin Cancer Screening A Qualitative Study
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DOI：
10.1001/jamadermatol.2019.5014
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发表时间：
2020-05-01
期刊：
影响因子：
10.9
通讯作者：
Mostaghimi, Arash
中科院分区：
文献类型：
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作者：
Nelson, Caroline A.;Perez-Chada, Lourdes Maria;Mostaghimi, Arash
人工智能（AI）的使用正在整个医学领域扩展。在皮肤病学方面，研究人员正在评估直接面向患者和临床医生的决策支持AI工具对皮肤病变进行分类的潜力。尽管人工智能有望改变患者参与医疗保健的方式，但患者的观点仍然知之甚少。目的探讨患者对AI的概念及AI在皮肤癌筛查中的应用。设计，设置，和参与者一个定性研究，采用扎根理论的方法进行半结构化的访谈分析，在普通皮肤科诊所在布里格姆妇女医院和黑色素瘤诊所在达纳法伯癌症研究所。入组了48例患者。每次访谈由2名研究者独立编码，采用评价者间信度测量;协调代码用于评估代码频率。研究于2019年5月6日至7月8日进行。主要成果和措施人工智能的概念，感知的好处和风险，人工智能的优势和劣势，人工智能的实施，人类和人工智能临床决策之间的冲突的反应，以及建议或反对人工智能。结果在48例患者中，26例（54%）为女性;平均（SD）年龄为53.3（21.7）岁。16例患者（33%）有黑色素瘤病史，16例患者（33%）仅有非黑色素瘤皮肤癌病史，16例患者（33%）无皮肤癌病史。24名患者接受了关于直接面向患者的AI工具的采访，24名患者接受了关于临床医生决策支持AI工具的采访。2个编码团队的评定者间可靠性评级分别为kappa = 0.94和kappa = 0.89。患者主要从认知角度对AI进行概念化。提高诊断速度（29名参与者[60%]）和获得医疗保健（29名[60%]）是AI用于皮肤癌筛查的最常见益处;增加患者焦虑是最常见的风险（19名[40%]）。患者认为更准确的诊断（33 [69%]）和不太准确的诊断（41 [85%]）分别是AI的最大优势和弱点。出现的主要主题是人类与AI之间共生的重要性（45 [94%]）。寻求活检是人类和AI临床决策之间冲突的最常见反应（32 [67%]）。总体而言，36名患者（75%）会向家人和朋友推荐AI。结论和相关性在这项定性研究中，如果以维护人类医患关系完整性的方式实施，患者似乎可以接受使用人工智能进行皮肤癌筛查。问题患者如何看待使用人工智能进行皮肤癌筛查？结果在布里格姆妇女医院和丹娜-法伯癌症研究所进行的定性研究评估了48例患者，33%的黑色素瘤的历史，33%的非黑色素瘤皮肤癌的历史，33%没有皮肤癌的历史。虽然75%的患者表示他们会向朋友和家人推荐人工智能，但94%的患者表示人类与人工智能之间共生的重要性。如果人类医患关系的完整性得到保护，患者似乎可以接受使用人工智能进行皮肤癌筛查。这项定性研究探讨了在皮肤科诊所接受护理的患者如何看待使用人工智能作为筛查工具。
Importance The use of artificial intelligence (AI) is expanding throughout the field of medicine. In dermatology, researchers are evaluating the potential for direct-to-patient and clinician decision-support AI tools to classify skin lesions. Although AI is poised to change how patients engage in health care, patient perspectives remain poorly understood. Objective To explore how patients conceptualize AI and perceive the use of AI for skin cancer screening. Design, Setting, and Participants A qualitative study using a grounded theory approach to semistructured interview analysis was conducted in general dermatology clinics at the Brigham and Women's Hospital and melanoma clinics at the Dana-Farber Cancer Institute. Forty-eight patients were enrolled. Each interview was independently coded by 2 researchers with interrater reliability measurement; reconciled codes were used to assess code frequency. The study was conducted from May 6 to July 8, 2019. Main Outcomes and Measures Artificial intelligence concept, perceived benefits and risks of AI, strengths and weaknesses of AI, AI implementation, response to conflict between human and AI clinical decision-making, and recommendation for or against AI. Results Of 48 patients enrolled, 26 participants (54%) were women; mean (SD) age was 53.3 (21.7) years. Sixteen patients (33%) had a history of melanoma, 16 patients (33%) had a history of nonmelanoma skin cancer only, and 16 patients (33%) had no history of skin cancer. Twenty-four patients were interviewed about a direct-to-patient AI tool and 24 patients were interviewed about a clinician decision-support AI tool. Interrater reliability ratings for the 2 coding teams were kappa = 0.94 and kappa = 0.89. Patients primarily conceptualized AI in terms of cognition. Increased diagnostic speed (29 participants [60%]) and health care access (29 [60%]) were the most commonly perceived benefits of AI for skin cancer screening; increased patient anxiety was the most commonly perceived risk (19 [40%]). Patients perceived both more accurate diagnosis (33 [69%]) and less accurate diagnosis (41 [85%]) to be the greatest strength and weakness of AI, respectively. The dominant theme that emerged was the importance of symbiosis between humans and AI (45 [94%]). Seeking biopsy was the most common response to conflict between human and AI clinical decision-making (32 [67%]). Overall, 36 patients (75%) would recommend AI to family members and friends. Conclusions and Relevance In this qualitative study, patients appeared to be receptive to the use of AI for skin cancer screening if implemented in a manner that preserves the integrity of the human physician-patient relationship.Question How do patients perceive the use of artificial intelligence for skin cancer screening? Findings A qualitative study conducted at the Brigham and Women's Hospital and the Dana-Farber Cancer Institute evaluated 48 patients, 33% with a history of melanoma, 33% with a history of nonmelanoma skin cancer only, and 33% with no history of skin cancer. While 75% of the patients stated that they would recommend artificial intelligence to friends and family members, 94% expressed the importance of symbiosis between humans and artificial intelligence. Meaning Patients appear to be receptive to the use of artificial intelligence for skin cancer screening if the integrity of the human physician-patient relationship is preserved.This qualitative study examines how the use of artificial intelligence as a screening tool is perceived by patients receiving care in a dermatology clinic.