Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

Background

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored.

Objectives

The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare?

Materials and methods

A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice.

Results

Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships.

Conclusion

There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships.

Implications

In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

Can robots recover a service using interactional justice as employees do? A literature review-based assessment

Interactional justice (e.g., empathy) plays a crucial role in service recovery. It relies on human social skills that would prevent it from automation. However, several considerations challenge this view. Interactional justice is not always necessary to recover service, and progress in social robotics enables service robots to handle social interactions. This paper reviews service recovery and social robotics literature and addresses whether service robots can use interactional justice as frontline employees do during service recovery. Results show service robots can replicate interactional justice norms, although with some considerations. Accordingly, we propose a research agenda for future studies.

Human-Like Movements of Industrial Robots Positively Impact Observer Perception

The number of industrial robots and collaborative robots on manufacturing shopfloors has been rapidly increasing over the past decades. However, research on industrial robot perception and attributions toward them is scarce as related work has predominantly explored the effect of robot appearance, movement patterns, or human-likeness of humanoid robots. The current research specifically examines attributions and perceptions of industrial robots-specifically, articulated collaborative robots-and how the type of movements of such robots impact human perception and preference. We developed and empirically tested a novel model of robot movement behavior and demonstrate how altering the movement behavior of a robotic arm leads to differing attributions of the robot's human-likeness. These findings have important implications for emerging research on the impact of robot movement on worker perception, preferences, and behavior in industrial settings.

Factors influencing the intention to use assistive technologies by older adults

Society is ageing at an unprecedented pace worldwide creating implications for the health and social care. Gerontechnology has been recognized as a solution that increases and supports the independency and well-being of older adults at home. This article aims to identify the most critical success factors effecting the adoption of an assistive gerontechnology by older adults in Poland. The object of the authors' interest was Rudy robot, an AI-enabled mobile solution helping users remain physically healthy, mentally sharp, and socially connected. The data was collected among Polish citizens using the CATI technique between November and December 2020. The number of returned questionnaires amounted to 824. The authors used Generalized Least Squares (GLS) of Structural Equation Modelling (GLS-SEM) to verify the hypotheses. The obtained results confirmed statistically significant relationships between the variables of perceived usefulness of Rudy robot and attitude reflecting the willingness to use this technology, as well as between perceived ease of use and perceived usefulness of robot. However, relationship between perceived ease of use and inclination to use this technology in the future was not statistically significant. The conducted research confirmed that the functionality of the analysed Rudy robot for older-adult care positively influences their intension to use it in the future for their own needs or family members. The obtained results confirmed usefulness of robots as assistive technology helping older adults.

Affective Attitudes Toward Robots at Work: A Population-Wide Four-Wave Survey Study

Robotization of work is progressing fast globally, and the process has accelerated during the COVID-19 pandemic. Utilizing integrated threat theory as a theoretical framework, this study investigated affective attitudes toward introducing robots at work using a four timepoint data (n = 830) from a Finnish working population longitudinal study. We used hybrid multilevel linear regression modelling to study within and between participant effects over time. Participants were more positive toward introducing robots at work during the COVID-19 pandemic than before it. Increased cynicism toward individuals’ own work, robot-use self-efficacy, and prior user experiences with robots predicted positivity toward introducing robots at work over time. Workers with higher perceived professional efficacy were less and those with higher perceived technology-use productivity, robot-use self-efficacy, and prior user experiences with robots were more positive toward introducing robots at work. In addition, the affective attitudes of men, introverts, critical personalities, workers in science and technology fields, and high-income earners were more positive. Robotization of work life is influenced by workers’ psychological well-being factors and perceived as a welcomed change in the social distancing reality of the pandemic.

Embodied Digital Technologies: First Insights in the Social and Legal Perception of Robots and Users of Prostheses

New bionic technologies and robots are becoming increasingly common in workspaces and private spheres. It is thus crucial to understand concerns regarding their use in social and legal terms and the qualities they should possess to be accepted as ‘co-workers’. Previous research in these areas used the Stereotype Content Model to investigate, for example, attributions of Warmth and Competence towards people who use bionic prostheses, cyborgs, and robots. In the present study, we propose to differentiate the Warmth dimension into the dimensions of Sociability and Morality to gain deeper insight into how people with or without bionic prostheses are perceived. In addition, we extend our research to the perception of robots. Since legal aspects need to be considered if robots are expected to be ‘co-workers’, for the first time, we also evaluated current perceptions of robots in terms of legal aspects. We conducted two studies: In Study 1, participants rated visual stimuli of individuals with or without disabilities and low- or high-tech prostheses, and robots of different levels of Anthropomorphism in terms of perceived Competence, Sociability, and Morality. In Study 2, participants rated robots of different levels of Anthropomorphism in terms of perceived Competence, Sociability, and Morality, and additionally, Legal Personality, and Decision-Making Authority. We also controlled for participants’ personality. Results showed that attributions of Competence and Morality varied as a function of the technical sophistication of the prostheses. For robots, Competence attributions were negatively related to Anthropomorphism. Perception of Sociability, Morality, Legal Personality, and Decision-Making Authority varied as functions of Anthropomorphism. Overall, this study contributes to technological design, which aims to ensure high acceptance and minimal undesirable side effects, both with regard to the application of bionic instruments and robotics. Additionally, first insights into whether more anthropomorphized robots will need to be considered differently in terms of legal practice are given.

Using social robot NAO for emotional support to children at a paediatric emergency department: a randomised clinical trial

Background

Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations.

Objective

This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels.

Methods

This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r).

Results

A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57).

Conclusions

SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting.

Trial Registration

ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909

What do humans feel with mistreated humans, animals, robots, and objects? Exploring the role of cognitive empathy

The aim of this paper is to present a study in which we compare the degree of empathy that a convenience sample of university students expressed with humans, animals, robots and objects. The present study broadens the spectrum of elements eliciting empathy that has been previously explored while at the same time comparing different facets of empathy. Here we used video clips of mistreated humans, animals, robots, and objects to elicit empathic reactions and to measure attributed emotions. The use of such a broad spectrum of elements allowed us to infer the role of different features of the selected elements, specifically experience (how much the element is able to understand the events of the environment) and degree of anthropo-/zoomorphization. The results show that participants expressed empathy differently with the various social actors being mistreated. A comparison between the present results and previous results on vicarious feelings shows that congruence between self and other experience was not always held, and it was modulated by familiarity with robotic artefacts of daily usage.

Feasibility Study on the Role of Personality, Emotion, and Engagement in Socially Assistive Robotics: A Cognitive Assessment Scenario

This study aims to investigate the role of several aspects that may influence human–robot interaction in assistive scenarios. Among all, we focused on semi-permanent qualities (i.e., personality and cognitive state) and temporal traits (i.e., emotion and engagement) of the user profile. To this end, we organized an experimental session with 11 elderly users who performed a cognitive assessment with the non-humanoid ASTRO robot. ASTRO robot administered the Mini Mental State Examination test in Wizard of Oz setup. Temporal and long-term qualities of each user profile were assessed by self-report questionnaires and by behavioral features extrapolated by the recorded videos. Results highlighted that the quality of the interaction did not depend on the cognitive state of the participants. On the contrary, the cognitive assessment with the robot significantly reduced the anxiety of the users, by enhancing the trust in the robotic entity. It suggests that the personality and the affect traits of the interacting user have a fundamental influence on the quality of the interaction, also in the socially assistive context.

“Don’t Get Distracted!”: The Role of Social Robots’ Interaction Style on Users’ Cognitive Performance, Acceptance, and Non-Compliant Behavior

Social robots are developed to provide companionship and assistance in the daily life of the children, older, and disable people but also have great potential as educational technology by facilitating learning. In these application areas, a social robot can take the role of a coach by training and assisting individuals also in cognitive tasks. Since a robot’s interaction style affects users’ trust and acceptance, customizing its behavior to the proposed tasks could, potentially, have an impact on the users’ performance. To investigate these phenomena, we enrolled sixty volunteers and endowed a social robot with a friendly and an authoritarian interaction style. The aim was to explore whether and how the robot’s interaction style could enhance users’ cognitive performance during a psychometric evaluation. The results showed that the authoritarian interaction style seems to be more appropriate to improve the performance when the tasks require high cognitive demands. These differences in cognitive performance between the groups did not depend on users’ intrinsic characteristics, such as gender and personality traits. Nevertheless, in the authoritarian condition, participants’ cognitive performance was related to their trust and the acceptance of the technology. Finally, we found that users’ non-compliant behavior was not related to their personality traits. This finding indirectly supports the role of the robot’s interaction style in influencing the compliance behavior of the users.