The influence of AI-driven chatbots on communication between patients and health care providers: A qualitative...

The rapid advancement and widespread use of AI-driven chatbots are reframing communication between patients and health care providers (HCPs), but the mechanisms of such changes remain unclear. This systematic review draws on the Ecological Model of Communication in Medical Encounters (EMCME) and presents a qualitative synthesis of patients' and HCPs' perspectives on how chatbots influence their communication.

This review was registered prospectively in PROSPERO (CRD420251070305). Following the PRISMA 2020 guidelines, six databases were systematically searched using terms related to chatbots, health care, and communication. Eligible studies were published in peer-reviewed journals from database inception to November 2025, reported empirical, qualitative findings, and focused on patients' and/or HCPs' perceptions of the impact of chatbots on their communication. Fifteen studies were included. Quality appraisal was conducted using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Thematic synthesis was used for analysis.

The findings demonstrate how chatbots impact the non-interpersonal and interpersonal contexts that frame patient-HCP communication. They change the non-interpersonal contexts by supporting patient-centred communication and care, introducing new opportunities and challenges for mediated information sharing, and changing considerations of health-related privacy and liability. The proliferation of chatbots reframes the interpersonal context through expanding linguistic and informational resources, enhancing awareness of empathy and relational needs, and changing interpersonal dynamics.

This review expands the EMCME literature and positions chatbots as a 'third party' in broad health communication systems. It highlights the need for access to quality health information. The changed interpersonal dynamics can intensify relational work during patient-HCP communication.

Policymakers, hospitals, HCPs, and patients need to recognise chatbots as a 'third party' in health communication and position them as additional tools alongside HCP care. Potential paths towards more effective use of chatbots involve improving patients' digital literacy through training and developing specialised chatbots co-designed by key stakeholders.