Balancing Efficiency and Empathy: Healthcare Providers' Perspectives on AI-Supported Workflows for Serious Illness Conversations in the Emergency Department

Abstract

Serious Illness Conversations (SICs), discussions about values and care preferences for patients with life-threatening illness, rarely occur in Emergency Departments (EDs), despite evidence that early conversations improve care alignment and reduce unnecessary interventions. We interviewed 11 ED providers to identify challenges in SICs and opportunities for technology support, with a focus on AI. Our analysis revealed a four-stage SIC workflow (identification, preparation, conduction, documentation) and barriers at each stage, including fragmented patient information, limited time and space, lack of conversational guidance, and burdensome documentation. Providers expressed interest in AI systems for synthesizing information, supporting real-time conversations, and automating documentation, but emphasized concerns about preserving human connection and clinical autonomy. This tension highlights the need for technologies that enhance efficiency without undermining the interpersonal nature of SICs. We propose design guidelines for ambient and peripheral AI systems to support providers while preserving the essential humanity of these conversations.

Figures (4)

• Figure 1: We systematically examined ED providers' current workflow of conducting SICs in EDs, which revealed four stages (Identification, Preparation, Conduction, and Documentation). Meanwhile, we uncovered specific challenges that ED providers encounter at each stage, as well as limitations in post-SIC that hinder the delivery of future SICs. Building on the insights, we identified how AI technologies could help address the challenges while being smoothly integrated into the clinical workflow. The role of AI technologies is designed to be ambient and peripheral, which allows ED providers to use them when needed.
• Figure 2: In this paper, we conducted semi-structured interviews with 11 ED providers to systematically examine their workflow of conducting SICs and challenges they face during their workflow. We also explored the AI opportunities and concerns in supporting ED-specific SIC workflow with our participants. Finally, we derived design guidelines grounded in our findings.
• Figure 3: Four phases in ED provider’s workflow for conducting SICs: (1) identify patients who need SICs, (2) prepare for SICs mentally and logistically, (3) conduct SICs, (4) document the key information from SICs. We also include who is involved in each phase, including ED Providers (emergency physicians or nurses), Patients, and Caregivers (family members or surrogates)
• Figure 4: This figure summarizes the key challenges ED providers face at each phase of their workflow of SICs. The rationale for identifying the key challenges was based on their impact on SICs rather than their frequency of mention. Specifically, we prioritized challenges that (1) most significantly impede or lead to a breakdown of the SIC process in EDs, or (2) elicit the most significant negative emotional responses from participants. Moreover, the figure maps the AI opportunities identified to address these challenges across each phase. Besides, the figure presents four design guidelines for SICs grounded in the unique challenges and needs of EDs.