JMIR Publications

ABSTRACT

Background:

Skin cancers, including melanoma and keratinocyte cancers, are amongst the commonest cancers worldwide and their incidence is rising in most populations. Earlier detection of skin cancer leads to better outcomes for patients. Artificial Intelligence (AI) technologies have been applied to skin cancer diagnosis, but many technologies lack clinical evidence and/or the appropriate regulatory approvals. There are few qualitative studies examining the views of relevant stakeholders, or evidence about implementation and positioning of AI technologies in the skin cancer diagnostic pathway.

Objective:

To understand the views of several stakeholder groups on the use of AI technologies to facilitate the early diagnosis of skin cancer including patients, members of the public, general practitioners, primary care nurse practitioners, dermatologists, and AI researchers.

Methods:

A qualitative, semi-structured interview study with 29 stakeholders. Participants were purposively sampled based on age, gender, and geographical location. Interviews were conducted via Zoom between September 2022 and May 2023. Transcribed recordings were analysed using thematic framework analysis. The framework for the non-adoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) was used to guide the analysis, to help understand the complexity of implementing diagnostic technologies in clinical settings.

Results:

Major themes were ‘the position of AI in the skin cancer diagnostic pathway’ and ‘the aim of the AI technology’; cross-cutting themes included trust, usability and acceptability, generalisability, evaluation and regulation, implementation, and long-term use. There was no clear consensus on where AI should be placed along the skin cancer diagnostic pathway but most participants saw the technology in the hands of either patients or primary care practitioners. Participants were concerned about the quality of the data used to develop and test AI technologies, and the impact this could have on their accuracy in clinical use with patients from a range of demographics and the risk of missing skin cancers. Ease of use and not increasing the workload of, already strained, healthcare services were important considerations for participants. Healthcare professionals and AI researchers reported a lack of established methods of evaluating and regulating AI technologies.

Conclusions:

This study is one of the first to examine the views of a wide range of stakeholders on the use of AI technologies to facilitate early diagnosis of skin cancer. The optimal approach and position in the diagnostic pathway for these technologies have not yet been determined. AI technologies need to be developed and implemented carefully and thoughtfully, with attention paid to the quality and representativeness of the data used for development, to achieve their potential.