Enhancing trust and agency: integrating citizen perspectives into AI-assisted shared decision-making in medicine

Abstract As artificial intelligence (AI) becomes increasingly integrated into clinical environments, questions of trust, transparency, and shared decision-making come to the fore. This article examines how public perspectives can influence the ethical and technical development of AI tools in medicine, drawing on empirical insights from an interdisciplinary project focused on developing AI to support the diagnosis and treatment of skin cancer. Rather than treating ethical concerns as external to technical design, we argue that they must be addressed from within the development process. In our case, this was achieved by integrating citizen feedback into iterative design loops within our interdisciplinary team, fostering closer alignment between AI functionalities and public values. Through focus group discussions with citizens and a constructivist grounded theory approach, we identified three key areas of concern: the evolving doctor–patient relationship, patient agency in AI-supported care, and the influence of specific medical contexts on public evaluations of AI. This article illustrates how these citizen perspectives can be meaningfully connected with the medical and technical considerations shaping the development of AI.