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Original Investigation
March 11, 2020

Patient Perspectives on the Use of Artificial Intelligence for Skin Cancer Screening: A Qualitative Study

Author Affiliations
  • 1Yale School of Medicine, Department of Dermatology, New Haven, Connecticut
  • 2Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Medical student, Boston University School of Medicine, Boston, Massachusetts
  • 4Medical student, School of Medicine, University of California, San Francisco
  • 5Medical student, University of Massachusetts Medical School, Worcester
  • 6Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
  • 7Stanford University School of Medicine, Department of Dermatology, Palo Alto, California
  • 8Department of Sociology, Yale University, New Haven, Connecticut
  • 9Harvard Medical School, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 10Department of Dermatology, Veterans Affairs Integrated Service Network 1, Jamaica Plain, Massachusetts
JAMA Dermatol. Published online March 11, 2020. doi:10.1001/jamadermatol.2019.5014
Key Points

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.

Abstract

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 κ = 0.94 and κ = 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.

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