Influence of AI-based decision support on shared decision making in hemodialysis: a Wizard of Oz experiment

Artificial Intelligence-based decision support systems (AI-DSS) to improve hemodialysis therapy are currently under development. However, the influence of AI-DSS on shared decision making (SDM) in hemodialysis patients has not been studied so far. We performed a Wizard of Oz experiment, using a sham AI-DSS suggesting ultrafiltration volume at the beginning of each dialysis session. We performed 10 patient interviews in 5 patients, and investigated views towards AI, different aspects of the SDM, and the influence of an AI-DSS on SDM in a real-life scenario. Five main topics were identified: (1) the patient as self-determined, (2) role of the medical staff, (3) other forms of automation, (4) attitude towards AI, (5) needs and preferences for future use of AI. The patients describe novel AI-DSS in dialysis as an opportunity to promote self-determination and to ensure more efficient therapy. At the same time, they describe the special relationship with the nursing staff and physicians, who, from the patients’ point of view, must be given control over an AI-DSS. This study provides first evidence regarding the influence of AI-DSS on SDM in the context of hemodialysis. Further studies should focus on other aspects that require SDM such as initiation of dialysis, and selection of dialysis modality. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project was funded by the Federal Ministry of Education and Research (BMBF, Germany) in the project "vALID: Al-Driven Decision-Making in the Clinic. Ethical, Legal and Societal Challenges" (grant agreement nos. 01GP1903A and 01GP1903B). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of Charité - Universitätsmedizin Berlin approved this study (EA1/325/21). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.