Trust when the healthcare ecosystem is integrated with Artificial Intelligence

Trust assumes a central role in the patient-physician relationship. However, with the advent of Artificial Intelligence (AI) medical tools in medicine the patient-physician relationship has become more complex. Given the multiple partners involved in the healthcare ecosystem, adopting a theoretical framework for analyzing trust is essential. Several models have tried to explain interpersonal trust in healthcare as a factor that predicts engagement in trusted behavior. However, these models focused on only one partner (patient, physician, or AI developer) in a trust relationship and considered only the trust expressed by that partner in the AI medical tool or in the counter-partner. To address this gap, we propose the Patient-AI medical tools-Physician Interpersonal Trust (PAIP-IT) model, which conceptualizes trusted behavior as the outcome of dynamic trust relationships: a) between the patient and the physician, b) between both the patient and the physician toward AI medical tools, c) between the patient and the physician mediated by AI medical tools. Furthermore, because these relational dynamics unfold within specific cultural, social, and institutional contexts, it is essential to also account for institutional trust.