“What Does a Chatbot Know About Life?”: Ill and Healthy Adults’ Perspectives on Artificial Intelligence Integration in Advance Care Planning

Abstract

Advance care planning (ACP) completion rates remain modest in the United States despite the benefits of ACP to patients’ quality of end of life. This mixed methods study explores adults’ (N = 203) perspectives on ACP and the potential use of artificial intelligence chatbots to facilitate this process. Participants identified as either living with life-limiting illnesses (N = 75) or as healthy (N = 128), and were mean age 64.02 (SD = 11.09); 48.8% men, 48.3% women; 55.7% disabled; and racially, socioeconomically, and religiously diverse. Participants were open to engaging with chatbots for logistical and informational ACP tasks but strongly preferred human communication for more personal or emotional conversations. Comfort with chatbot-facilitated ACP increased when chatbots were transparent, text-based, and used in conjunction with healthcare providers. Findings underscore the continued primacy of human connection in ACP and highlight design considerations—including transparency and human integration—under which chatbots may responsibly supplement this process and gain public acceptance.