Abstract
Artificial intelligence (AI) is increasingly being integrated into healthcare, particularly in data-intensive chronic diseases that rely on longitudinal monitoring and shared decision-making. Multiple sclerosis is a prototypical example of such care, but real-world benefit will depend on whether people accept AI support in different clinical roles. We conducted a cross-sectional, web-based survey among 241 people with MS (pwMS) to assess comfort with AI across eight clinical domains and to identify predictors of acceptance. We derived an artificial-intelligence attitudes composite with high internal consistency (Cronbach alpha = 0.90). Overall acceptance was moderate (mean 3.39 ± 0.78). Acceptance differed across domains, demonstrating a responsibility gradient: comfort was highest for supportive applications such as chronic management (54.4%) and symptom screening (50.2%), but lower for treatment selection (38.6%) and diagnosis (35.3%; P < 0.001). In multivariable models, frequent general AI use (at least weekly; 30.7%) was the strongest independent predictor of acceptance (P < 0.001). Acceptance also differed by region (Eastern vs Western Germany, P = 0.025), whereas clinical disability was not significantly associated. Older age was associated with lower acceptance of AI-supported management. Most participants viewed AI as a logistical support tool but, assuming equal diagnostic accuracy, 78.8% preferred joint artificial-intelligence-clinician decision-making with clinician final responsibility. These findings indicate that acceptance is context-dependent and aligns more closely with prior familiarity than with disease severity. Implementation should move beyond technical validation to transparent, clinician-led’human-in-the-loop’ workflows with explicit accountability and staged adoption beginning with low-risk use cases.
Author Summary We use artificial intelligence more and more in everyday life, and similar tools are now being introduced into medical care. For long-term conditions such as multiple sclerosis, digital systems could help manage large amounts of clinical information and support monitoring between visits. At the same time, these tools will only be useful if the people receiving care are willing to use them and understand what role they play.
In this study, we asked 241 people living with multiple sclerosis in Germany how comfortable they would feel with artificial intelligence in different parts of care. We found that comfort depended strongly on the task. Participants were most open to artificial intelligence when it supported practical, lower-risk functions such as ongoing monitoring or symptom screening, and they were more cautious when it was described as influencing diagnosis or treatment choices. Most participants wanted clinicians to remain responsible for final decisions. Acceptance was higher among people who already used artificial intelligence frequently in everyday life, and it differed by age and by region. Our findings suggest that successful implementation will require more than technical performance: it should be introduced transparently, with clinician oversight, and in a stepwise way that builds familiarity without shifting responsibility away from the clinical team.
Competing Interest Statement
This research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. H.I. received speaker honoraria from Roche and financial support for research activities from Merck, Novartis, Teva, Neuraxpharm, Biogen, and Alexion. L.M. has received honoraria for lecturing, consulting, and travel expenses for attending meetings from Biogen, Merck, Sanofi, argenX, Roche, Alexion, and Novartis. His research is funded by the German Multiple Sclerosis Foundation (DMSG) and the Deutsche Forschungsgemeinschaft (DFG). N.v.H. reports honoraria, travel support and/or consulting fees from Roche, Merck, DMSG, EMSP, Amgen, Klinikum Rechts der Isar, Don't Be Patient, Rewoso, DawnHealth, Coloplast, Biogen and Bayer. She received podcast-related financial support from Novartis, Sanofi, the Hertie Foundation, Coloplast, Medtronic and g.tec medical engineering. She served in Patient Advisory Boards for Roche and Merck. S.M. has received honoraria for lecturing and travel expenses for attending meetings from Almirall, Amicus Therapeutics Germany, ArgenX, Bayer Health Care, Biogen, Celgene, Diamed, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Neuraxpharm, Novo Nordisk, ONO Pharma, Roche, Sanofi-Aventis, Chugai Pharma, QuintilesIMS, and Teva. His research is funded by the German Ministry for Education and Research (BMBF), Bundesinstitut für Risikobewertung (BfR), Deutsche Forschungsgemeinschaft (DFG), Else Kröner Fresenius Foundation, Gemeinsamer Bundesausschuss (G-BA), German Academic Exchange Service, Hertie Foundation, Interdisciplinary Center for Clinical Studies (IZKF) Muenster, German Foundation Neurology, and by Alexion, Almirall, Amicus Therapeutics Germany, Biogen, Diamed, Fresenius Medical Care, Genzyme, HERZ Burgdorf, Merck Serono, Novartis, ONO Pharma, Roche, and Teva, all outside the scope of this study. S.G. declares the following competing financial interests: he has or has had consulting relationships with Una Health GmbH, Lindus Health Ltd., Flo Ltd, Thymia Ltd., FORUM Institut für Management GmbH, High-Tech Gründerfonds Management GmbH, and Ada Health GmbH and holds share options in Ada Health GmbH. H.B.H. reports financial suppor for research activities from Novartis. S.G. is supported by the German Federal Ministry of Health (DEEP LIVER, ZMVI1-2520DAT111 SWAG, 01KD2215B), the Max-Eder-Programme of the German Cancer Aid (grant no. 70113864), the German Federal Ministry of Education and Research (PEARL, 01KD2104C CAMINO, 01EO2101 SWAG, 01KD2215A TRANSFORM LIVER, 031L0312A TANGERINE, 01KT2302 through ERA-NET Transcan), the German Academic Exchange Service (SECAI, 57616814), the German Federal Joint Committee (Transplant.KI, 01VSF21048) the European Union?s Horizon Europe and innovation programme (ODELIA, 101057091 GENIAL, 101096312) and the National Institute for Health and Care Research (NIHR, NIHR213331) Leeds Biomedical Research Centre. M.P. reports no conflicts of interest related to this study. He has received honoraria for lecturing and travel expenses for attending meetings from Alexion, ArgenX, Bayer Health Care, Biogen, Hexal, Merck Serono, Neuraxpharm, Novartis, Roche, Sanofi-Aventis, Takeda, and Teva. His research is funded by ArgenX, Biogen, Hexal, and Novartis, all outside the scope of this study. T.Z. reports scientific advisory board and/or consulting for Biogen, Roche, Novartis, Celgene, and Merck compensation for serving on speakers bureaus for Roche, Novartis, Merck, Neuraxpharm, Sanofi, Celgene, and Biogen and research support from Biogen, Novartis, Merck, and Sanofi. I.V., D.S., J.W., I.G.-C., and R.H. have nothing to declare.
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Ethical approval was waived by the Ethics Committee at TU Dresden University of Technology (Ethikkommission an der Technischen Universität Dresden), Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany in line with local institutional policy for an anonymous, minimal-risk survey without collection of personally identifiable information.
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