Me, my doctor and AI: a qualitative interview study on patients' requirements for trustworthy use of AI-CDSS in ophthalmology

Objective

Artificial intelligence-based clinical decision support systems (AI-CDSS) are increasingly entering care and redefining how medical decisions are made. As patients are directly affected by hybrid physician-AI decisions without interacting with the system itself, trust, transparency and involvement in decision-making become important concerns. This study explored patients' requirements for trustworthy use of AI-CDSS in ophthalmology, with particular attention to expectations regarding disclosure of AI use and informational needs. Methods and analysis: We conducted semi-structured interviews with 23 ophthalmology patients and caregivers (aged 22-84 years) in Germany between January and March 2026. Participants were recruited via patient organisations, ophthalmology practices, clinics, social media, or purposively, with the aim of obtaining a sample diverse in age, gender and eye conditions. We used inductive qualitative content analysis to examine their perceptions of AI-assisted decision-making, factors shaping trust in AI-supported medical decisions and expectations regarding communication and AI disclosure.