Abstract
BACKGROUND: Multimorbidity, living with 2 or more long-term health conditions, is increasing globally and now affects over one-quarter of adults in England. People with multiple long-term conditions (MLTC) face complex health and treatment challenges, often experiencing fragmented care within systems oriented toward single-disease management. Artificial intelligence (AI) has the potential to support clinicians and patients by analyzing complex health data, optimizing treatment strategies, and predicting disease trajectories. OBJECTIVE: The OPTIMAL (Optimizing Therapies, Disease Trajectories, and AI-Assisted Clinical Management for Patients Living with Complex Multimorbidity) project aims to develop AI-enabled tools to support shared decision-making in primary care. This study explored how patients with MLTC perceive the use of AI to inform joint decision-making in primary care. METHODS: Semistructured interviews were conducted via telephone or video call with 29 adults living with MLTC between July and November 2023. Participants were recruited through general practitioner practices via the Clinical Practice Research Datalink and community-based organizations across the West Midlands. Interviews were transcribed verbatim and analyzed thematically using an inductive approach. Members of a patient advisory group were involved in developing study materials, refining the interview guide, and reviewing emerging findings to ensure relevance and authenticity. RESULTS: Participants identified potential benefits of AI in enhancing consultation efficiency and accuracy, improving access to information for patients and clinicians, promoting early detection of health changes, and reducing health care inequalities. However, concerns were raised about the loss of human interaction, data privacy and security, transparency of algorithms, and the potential for bias and inequity in AI systems. Trust and acceptance varied by age and familiarity with technology. Some participants expressed uncertainty about what AI entails and how it could be used in primary care. CONCLUSIONS: Patients with MLTC viewed AI-assisted decision-making in primary care with cautious optimism. While many recognized potential benefits for coordination and personalization of care, others expressed reservations about privacy, fairness, and the risk of diminished human connection.