JMIR Publications

ABSTRACT

Background:

Spiritual care providers are increasingly challenged to address the introduction of Artificial Intelligence (AI) in settings within the ethical, theological, and organizational bounds of their employers and religious or worldview communities. However, empirical data on professional perspectives regarding AI implementation in spiritual care remains scarce.

Objective:

To conduct the first empirical investigation of AI use cases, risks and benefits, theological and ethical considerations and relevant professional competencies from a multistakeholder expert perspective.

Methods:

An international, multistakeholder modified e-Delphi study was conducted in two rounds. A purposive sample of 149 subject experts was recruited, including board-certified (or equivalent) spiritual care providers employed at a medium or large health care organization; managers, supervisors, and directors of spiritual care departments; academic leaders in the research, practice, and education of spiritual care; experts in the use of AI in religious and spiritual care contexts; and experts in the ethics and theology of technology use in religious contexts. Round 1 was completed by 102 of 149 invited participants (response rate 102/149, 68.5%); round 2 was completed by 83 panelists (response rate 83/102, 81.4%). Consensus was defined using combined measures of variance and directionality. Items with strong agreement (median of 3 or 4, IQR ≤1, agreement ≥80%) were considered to have achieved consensus.

Results:

In round 2, 77 of 138 items achieved predefined consensus criteria. The panel strongly agreed that AI can currently assist with or enhance administrative and routine tasks (77/81, 95.1%), informational tasks (74/79, 93.7%), documentation (67/80, 83.8%), and spiritual care research (65/77, 84.4%). Agreement was lower for relational, patient-facing tasks such as creating supportive spaces (30/69, 43.5%), direct patient engagement (32/76, 42.1%), and conducting ritual tasks (32/76, 42.1%). Panelists more strongly endorsed the future potential of AI across all task categories. Overall, 38 of 83 panelists (45.8%) perceived the benefits of AI in spiritual care to outweigh the risks. The highest-ranked risks were loss of human connection, dehumanization of spiritual care, and uncritical use of AI. The highest-ranked professional competencies were judging AI applicability and identifying boundaries of its use, safeguarding patient privacy and data, and assessing and mitigating risks.

Conclusions:

This study establishes the perceived relevance of AI in spiritual care beyond patient–provider chatbots, and offers a granular and actionable foundation for future research, policy, and implementation in this emerging field. Findings suggest that while AI is perceived to offer utility across administrative, informational, and select clinical tasks, implementation requires ethical and theological guidance, strong safeguards, and new professional competencies. Direct relational care is widely perceived to remain a primarily human responsibility.