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

Despite the benefits of advance care planning to patients’ quality of life and end of life, completion rates remain modest in the United States. This mixed methods study explores adults’ perspectives on advance care planning and the potential use of artificial intelligence chatbots to facilitate this process. Using an exploratory design, we surveyed 203 adults, including individuals 18 and older living with life-limiting illnesses (n = 75) and individuals 50 and older who identified as healthy (n = 128). Across the full sample, participants were 64.02 years old (SD = 11.09); 48.8% men, 48.3% women, 2.5% other gender identity; and 55.7% disabled. Participants represented diverse racial, socioeconomic, and religious backgrounds, and most had given consideration to end-of-life care. Findings revealed some openness to engaging with chatbots to facilitate advance care planning, particularly for logistical or informational tasks. However, for advance care planning conversations of a more personal or emotional nature, participants strongly preferred human communication characterized by empathy and trust, qualities they felt chatbots currently lack. Participants’ comfort with chatbot-facilitated advance care planning increased when chatbots were portrayed as transparent, were text-based, and were used in conjunction with healthcare providers. Ultimately, while chatbots may serve as supportive tools in advance care planning, their design must prioritize transparency and human integration to gain broader acceptance. These findings underscore the continued primacy of human connection in end-of-life planning and highlight the conditions under which artificial intelligence chatbots may responsibly supplement, but not replace, this process.