Conditional Trust and Shared Responsibility in AI-Assisted Brain Tumour Surgery: A Qualitative Study of Patients, Family Surrogates, and Neurosurgeons

Hua Feng; Linda Chiuman; Dewi Sartika

doi:10.61919/j1617066

Authors

Hua Feng Universitas Prima Indonesia, Indonesia Author
Linda Chiuman Universitas Prima Indonesia, Indonesia Author
Dewi Sartika Universitas Prima Indonesia, Indonesia Author

DOI:

https://doi.org/10.61919/j1617066

Keywords:

artificial intelligence; brain tumour surgery; qualitative research; shared decision-making; uncertainty; trust; family surrogates

Abstract

Background: Artificial intelligence (AI) is increasingly applied in neuro-oncology for imaging, prognostic modelling, functional-risk estimation, and surgical planning. Its clinical acceptability depends not only on predictive performance but also on how stakeholders interpret reliability, uncertainty, communication, and responsibility. Objective: To explore how patients, family surrogates, and neurosurgeons understood AI reliability, communication, uncertainty, responsibility, family involvement, and decision-making confidence in AI-assisted brain tumour surgery. Methods: A qualitative interview study was conducted in tertiary neurosurgical and neuro-oncology settings in Indonesia. Maximum-variation purposive sampling included 25 participants: 10 patients, 8 family surrogates, and 7 neurosurgeons. Semi-structured interviews explored perceived AI reliability, clinician–AI agreement or disagreement, uncertainty, family involvement, confidence, and acceptable safeguards. Interviews lasted 45–75 minutes, were audio-recorded, transcribed verbatim, checked, and de-identified. Data were analysed using reflexive thematic analysis with within-group, cross-group, and negative-case comparison. Results: Five themes emerged: AI as a second opinion rather than an autonomous authority; communication as translation of probabilities into meaningful consequences; confidence despite acknowledged uncertainty; relational responsibility involving patients, families, and clinicians; and governance conditions including local applicability, fairness, accountability, auditability, and clinician override. Trust was conditional rather than absolute, and transparently explained clinician disagreement with AI could strengthen confidence. Conclusion: AI-assisted brain tumour surgery was considered most acceptable when AI supplemented rather than replaced human judgement. Trust depended on understandable communication, acknowledged uncertainty, patient values, negotiated family involvement, clinician scrutiny, and visible accountability

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