Barriers and Facilitators to Trustworthy and Ethical AI-enabled Medical Care From Patient and Healthcare Provider Perspectives: A Literature Review

BackgroundArtificial intelligence (AI) and machine learning (ML) are increasingly used for prevention, diagnosis, monitoring, and treatment of cardiovascular diseases. Despite the potential for AI/ML to improve care, ethical concerns and mistrust in AI-enabled health care exist among the public and medical community. To inform practice guidelines and regulatory policies that facilitate ethical and trustworthy use of AI in medicine, we conducted a literature review to identify key ethical and trust barriers and facilitators from patients and healthcare providers perspectives when using AI in cardiovascular care. MethodsIn this rapid literature review, we searched six bibliographic databases to identify publications discussing transparency, trust, or ethical concerns (outcomes of interest) associated with AI/ML-based medical devices (interventions of interest) in the context of cardiovascular care from patients, caregivers, or healthcare providers perspectives. The search was completed on May 24, 2022 and was not limited by date or study design. ResultsAfter reviewing 7,925 papers from six databases and 3,603 papers identified through citation chasing, 145 articles were included. Key ethical concerns included privacy, security, or confidentiality issues; risk of healthcare inequity or disparity; risk of patient harm; accountability and responsibility concerns; problematic informed consent and potential loss of patient autonomy; and issues related to data ownership. Major trust barriers included data privacy and security concerns, potential risk of patient harm, perceived lack of transparency about AI-enabled medical devices, concerns about AI replacing human aspects of care, concerns about prioritizing profits over patients interests, and lack of robust evidence related to the accuracy and limitations of AI-based medical devices. Ethical and trust facilitators included ensuring data privacy and data validation, conducting clinical trials in diverse cohorts, providing appropriate training and resources to patients and healthcare providers and improving their engagement in different phases of AI implementation, and establishing further regulatory oversights. ConclusionThis review revealed key ethical concerns and barriers and facilitators of trust in AI-enabled medical devices from patients and healthcare providers perspectives. Mitigation strategies, including enhancing regulatory oversight on the use of patient data and promoting AI safety and transparency are needed for effective implementation of AI in cardiovascular care.