Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered Clinical Decision Support System for Depression Treatment: A Longitudinal Feasibility Study (Preprint)

BACKGROUND Approximately two thirds of patients with major depressive disorder (MDD) do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence (AI)-powered clinical decision support systems (CDSS) to assist physicians in their treatment selection and management, improving personalization and use of best practices such as measurement-based care. Previous literature shows that in order for digital mental health tools to be successful, the tool must be easy to use for patients and physicians and feasible within existing clinical workflows. OBJECTIVE We examine the feasibility of an AI-powered clinical decision support system, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural-network based individualized treatment remission prediction. METHODS Due to COVID-19, the study was adapted to be completed entirely at a distance. Seven physicians recruited outpatients diagnosed with MDD as per DSM-V criteria. Patients completed a minimum of one visit without the CDSS (baseline) and two subsequent visits where the CDSS was used by the physician (visit 1 and 2). The primary outcome of interest was change in session length after CDSS introduction, as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semi-structured interviews. RESULTS Seventeen patients enrolled in the study; 14 completed. There was no significant difference between appointment length between visits (introduction of the tool did not increase session length). 92.31% of patients and 71.43% of physicians felt that the tool was easy to use. 61.54% of the patients and 71.43% of the physicians rated that they trusted the CDSS. 46.15% of patients felt that the patient-clinician relationship significantly or somewhat improved, while the other 53.85% felt that it did not change. CONCLUSIONS Our results confirm the primary hypothesis that the integration of the tool does not increase appointment length. Findings suggest the CDSS is easy to use and may have some positive effects on the patient-physician relationship. The CDSS is feasible and ready for effectiveness studies. CLINICALTRIAL NCT04061642