Ethics in Patient Preferences for Artificial Intelligence-Drafted Responses to Electronic Messages

Abstract

Importance: The rise of patient messages sent to clinicians via a patient portal has directly led to physician burnout and dissatisfaction, prompting uptake of artificial intelligence (AI) to alleviate this burden. It is important to understand patient preferences around AI in patient-clinician communication as ethical guidelines on appropriate use and disclosure (patient notification of AI use) are developed.

Objective: To analyze patient preferences regarding use of AI in electronic messages.

Design, setting, and participants: A survey study was conducted within the Duke University Health System's patient advisory committee, consisting of individuals 18 years or older who participate in periodic surveys to inform health system patient care practices. Multiple surveys were administered to test the impact of different factors, including response author, disclosure (AI, human, or none), and seriousness of the topic. A follow-up survey assessed preferred disclosure verbiage. Surveys were administered from October 31 to December 11, 2023.

Exposure: Multiple surveys.

Main outcomes and measures: Participants rated their overall satisfaction, usefulness of the information, and perceived level of care on a 5-point Likert scale.

Results: Of the 2511 members surveyed, 1455 (57.9%) responded, with respondents being older (median age, 57 [IQR, 49-70] vs 53 [IQR, 41-62] years), more educated (872 of 1083 [80.5%] vs 319 of 440 [72.5%] with a college or graduate degree), and predominantly female (921 [63.3%]). Participants preferred AI- compared with human-drafted responses, with a mean difference for satisfaction of -0.30 (95% CI, -0.37 to -0.23) points, usefulness of -0.28 (95% CI, -0.34 to -0.22) points, and perception they were cared for of -0.43 (95% CI, -0.50 to -0.37) points. Participants tended to have higher satisfaction with a human disclosure over AI disclosure, with a mean difference of 0.13 (95% CI, 0.05-0.22) points, and with no disclosure over AI authorship disclosure, with a mean difference of 0.09 (95% CI, 0.01-0.17) points. Regardless of author or disclosure type, more than 75% of respondents were satisfied (agree or strongly agree) with the response.

Conclusions and relevance: In this survey study, participants expressed a mild preference for messages written by AI but had a slightly decreased satisfaction when told AI was involved. Patient experience must be considered along with ethical implementation of AI. Although AI disclosure may slightly reduce satisfaction, disclosure should be maintained to uphold patient autonomy and empowerment.

Figure 1.. Change in Preference Scores Stratified by Response Author

The mean change in a 5-point Likert scale for the responses written by artificial intelligence (AI) vs a human is shown in a forest plot. Tabulated results with P values are included in eTable 4 in Supplement 1.

Figure 2.. Participant Responses Stratified by Human or Artificial Intelligence (AI) Author

Figure 3.. Change in Preference Scores Stratified by Disclosure

The mean change in a 5-point Likert scale when the author was disclosed as artificial intelligence (AI), human, or no disclosure is shown in forest plots. Analyses are independent of the actual response author or topic. Tabulated results with P values are included in eTable 4 in Supplement 1.

Figure 4.. Participant Responses Stratified by Human, Artificial Intelligence (AI), or No Disclosure