J Med Internet Res. 2026 Jul 30;28:e87254. doi: 10.2196/87254.
ABSTRACT
BACKGROUND: AI-powered chatbots offer new opportunities to enhance patient education; however, their integration may reshape patterns of information interactions and trust relationships among patients, caregivers, and nurses. Evidence remains limited on how these stakeholders perceive the value and risks of AI-powered chatbots, and on their potential effects on nurse-patient trust.
OBJECTIVE: This study explores patients', caregivers', and nurses' attitudes toward and experiences with integrating AI-powered chatbots into patient education and identifies perceived benefits, implementation challenges, potential effects on trust, and the supportive conditions required for safe integration.
METHODS: This qualitative study was conducted from April to July 2025. Patients and caregivers were recruited from a tertiary general hospital using maximum variation purposive sampling, while nurses were recruited through snowball sampling from 6 hospitals of varying tiers. Data were collected using a sociodemographic questionnaire and semistructured, in-depth interviews. Interview recordings were transcribed verbatim and analyzed using reflexive thematic analysis, with NVivo used for coding and theme development. Sociodemographic data were analyzed descriptively.
RESULTS: A total of 60 participants were included: 29 patients, 17 caregivers, and 14 nurses. Four themes were identified: perceptions and maintenance of nurse-patient trust, conditional acceptance and practical needs, functional optimization and implementation safeguards, and nurses' role pressures and competency restructuring. All 3 stakeholder groups recognized the potential of AI-powered chatbots to address unmet information support needs in patient education but expressed reservations about their accuracy, personalization, and transparency. AI-powered chatbots were not perceived as a direct threat to nurse-patient trust. However, nurses were more sensitive to potential trust tensions, increased explanation burden, and expanded professional responsibilities, highlighting the need for competency restructuring. Stakeholder groups also differed in their perceptions of the conditions required to maintain nurse-patient trust. Limited digital health literacy and the digital divide affecting older patients were major barriers to integrating AI-powered chatbots into patient education.
CONCLUSIONS: Patients, caregivers, and nurses were generally cautiously open to integrating AI-powered chatbots into patient education, although their assessments of benefits and risks differed by role. AI-powered chatbots may be best positioned as adjunctive information-support tools. Their safe use should be tailored to patient characteristics, information risk, and clinical context, with nurses' professional oversight and coordinated support across governance, technical, and clinical implementation levels.
PMID:42531560 | DOI:10.2196/87254