JMIR Publications

ABSTRACT

Background:

Physician autonomy has been found to play a role in physician acceptance and adoption of artificial intelligence in medicine. However, there is still no consensus in the literature on how to define and assess physician autonomy. Furthermore, there is a lack of research focusing specifically on the effects of AI on physician autonomy.

Objective:

This scoping review addresses the following research questions: (1) How do studies conceptualize and assess physician autonomy? (2) Which aspects of physician autonomy are addressed by these studies? (3) What are the potential benefits and harms of AI for physician autonomy identified by these studies?

Methods:

We performed a scoping review of qualitative studies on AI and physician autonomy published before Nov 6th, 2023, by searching Medline and Web of Science. To answer research question (1), we determined whether the included studies explicitly include physician autonomy as a research focus and whether their interview, survey and focus group questions explicitly name or implicitly include aspects of physician autonomy. To answer (2), we extracted the qualitative results of the studies, categorizing them into the seven components of physician autonomy introduced by Schulz & Harrison. We then inductively formed subcomponents based on the results of the included studies in each component. To answer (3), we summarized potential harmful and beneficial effects of AI on physician autonomy in each of the inductively formed subcomponents.

Results:

The search yielded 369 articles after duplicates were removed. Of these, 27 remained after titles and abstracts were screened. After full texts were screened, we included a total of seven qualitative studies. Most studies did not explicitly name physician autonomy as a research focus or explicitly address physician autonomy in their interview, survey and focus group questions. No studies addressed a complete set of components of physician autonomy; while three components were addressed by all included studies, two components were addressed by none. We identified a total of 11 subcomponents for the five components of physician autonomy that were addressed by at least one study. For most of these subcomponents, studies reported both potential harms and potential benefits of AI for physician autonomy.

Conclusions:

Little research to date has explicitly addressed the effects of AI on physician autonomy and existing results on these effects are mixed. Further qualitative and quantitative research is needed that focuses explicitly on physician autonomy and addresses all relevant components of physician autonomy.