Exploring the feasibility of an artificial intelligence based clinical decision support system for cutaneous melanoma detection in primary care – a mixed method study

• Published in: Scandinavian journal of primary health care Vol. 42; no. 1; pp. 51 - 60
• Main Authors: Helenason, Jonatan, Ekström, Christoffer, Falk, Magnus, Papachristou, Panagiotis
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis LLC 2024; Taylor & Francis; Taylor & Francis Group
• Subjects: Accuracy; Artificial Intelligence; Clinical decision making; clinical decision support system; Credibility; Cutaneous Melanoma; Decision support systems; Decision Support Systems, Clinical; Feasibility; Feasibility Studies; Humans; Interviews; Melanoma; Melanoma - diagnosis; Mixed methods research; mobile health; Physicians; Primary care; primary care physicians; Primary Health Care - methods; Scientific evidence; Skin melanoma; Skin Neoplasms - diagnosis; Usability; clinical decision support system; Cutaneous Melanoma; mobile health; Artificial Intelligence; primary care physicians
• ISSN: 0281-3432; 1502-7724; 1502-7724
• DOI: 10.1080/02813432.2023.2283190

Skin examination to detect cutaneous melanomas is commonly performed in primary care. In recent years, clinical decision support systems (CDSS) based on artificial intelligence (AI) have been introduced within several diagnostic fields. This study employs a variety of qualitative and quantitative methodologies to investigate the feasibility of an AI-based CDSS to detect cutaneous melanoma in primary care. Fifteen primary care physicians (PCPs) underwent near-live simulations using the CDSS on a simulated patient, and subsequent individual semi-structured interviews were explored with a hybrid thematic analysis approach. Additionally, twenty-five PCPs performed a reader study (diagnostic assessment on the basis of image interpretation) of 18 dermoscopic images, both with and without help from AI, investigating the value of adding AI support to a PCPs decision. Perceived instrument usability was rated on the System Usability Scale (SUS). From the interviews, the importance of trust in the CDSS emerged as a central concern. Scientific evidence supporting sufficient diagnostic accuracy of the CDSS was expressed as an important factor that could increase trust. Access to AI decision support when evaluating dermoscopic images proved valuable as it formally increased the physician's diagnostic accuracy. A mean SUS score of 84.8, corresponding to 'good' usability, was measured. AI-based CDSS might play an important future role in cutaneous melanoma diagnostics, provided sufficient evidence of diagnostic accuracy and usability supporting its trustworthiness among the users.