Artificial Intelligence in Spiritual Care: Modified Delphi Study

BACKGROUND: Spiritual care providers are increasingly challenged to address the introduction of AI within the ethical, theological, and organizational bounds of their employers and religious or worldview communities. However, empirical data on professional perspectives regarding AI implementation in spiritual care remain scarce. OBJECTIVE: This study aimed to conduct the first empirical investigation of AI use cases, risks and benefits, theological and ethical considerations, and relevant professional competencies from a multistakeholder expert perspective. METHODS: An international, multistakeholder modified Delphi study was conducted in 2 rounds. A purposive sample of 149 subject experts was recruited. Panelists rated 213 items spanning task assistance and substitution, risks and benefits, theological and ethical considerations, limits, and competencies. Consensus was defined using combined measures of variance and directionality. Exploratory subgroup analyses assessed whether ratings differed across professional and demographic groups. RESULTS: Round 1 was completed by 102 of 149 invited panelists (response rate 68.5%); round 2 was completed by 83 panelists (response rate 81.4%). In round 2, strong agreement emerged that AI can currently assist with or enhance administrative and routine tasks (77/81, 95.1%), informational tasks (74/79, 93.7%), documentation (67/80, 83.8%), and spiritual care research (65/77, 84.4%). Agreement was lower for relational, patient-facing tasks such as creating supportive spaces (30/69, 43.5%), direct patient engagement (32/76, 42.1%), and conducting ritual tasks (32/76, 42.1%). Panelists favored AI assistance over substitution and rated the future potential of AI above its current capabilities. The highest-ranked benefit that reached consensus was improved screening and triage; the highest-ranked risk was loss of human connection. Overall, 45.8% (38/83) of panelists judged the benefits of AI in spiritual care to outweigh the risks. The panel converged strongly on professional limits but was more divided on the underlying theological and ethical objections. The most strongly endorsed competencies were judging AI's applicability and the boundaries of its use, safeguarding patient privacy and data, and assessing and mitigating risks. Subgroup analyses produced few robust differences. CONCLUSIONS: This study provides the first task-level map of expert opinion on AI in spiritual care, suggesting that current expert views are task-specific, future-oriented, and conditional. AI is seen as capable of assisting with administrative, informational, documentation, and research tasks. Direct relational care is widely regarded as a primarily human responsibility, and several tasks that experts judged AI capable of assisting with or substituting remain ethically complex. Experts converged on practical safeguards, including human oversight, evidence-based implementation, privacy protection, and limits on AI decision-making, and on required competencies, even as the theological and ethical rationales behind them remained contested. This suggests that professional guidance may be achievable at an early stage of AI adoption and can inform future research, guideline development, and curriculum design.