Clinical trials play an important role in cancer care and research, yet participation rates remain low. We developed MSK-MATCH (Memorial Sloan Kettering Multi-Agent Trial Coordination Hub), an AI system for automated eligibility screening from clinical text. MSK-MATCH integrates a large language model with a curated oncology trial knowledge base and retrieval-augmented architecture providing explanations for all AI predictions grounded in source text. In a retrospective dataset of 88,518 clinical documents from 731 patients across six breast cancer trials, MSK-MATCH automatically resolved 61.9% of cases and triaged 38.1% for human review. This AI-assisted workflow achieved 98.6% accuracy, 98.4% sensitivity, and 98.7% specificity for patient-level eligibility classification, matching or exceeding performance of the human-only and AI-only comparisons. For the triaged cases requiring manual review, prepopulating eligibility screens with AI-generated explanations reduced screening time from 20 minutes to 43 seconds at an average cost of $0.96 per patient-trial pair.

AI has the potential to augment human decision making. However, even high-performing models can produce inaccurate predictions when deployed. These inaccuracies, combined with automation bias, where humans overrely on AI predictions, can result in worse decisions. Selective prediction, in which potentially unreliable model predictions are hidden from users, has been proposed as a solution. This approach assumes that when AI abstains and informs the user so, humans make decisions as they would without AI involvement. To test this assumption, we study the effects of selective prediction on human decisions in a clinical context. We conducted a user study of 259 clinicians tasked with diagnosing and treating hospitalized patients. We compared their baseline performance without any AI involvement to their AI-assisted accuracy with and without selective prediction. Our findings indicate that selective prediction mitigates the negative effects of inaccurate AI in terms of decision accuracy. Compared to no AI assistance, clinician accuracy declined when shown inaccurate AI predictions (66% [95% CI: 56%-75%] vs. 56% [95% CI: 46%-66%]), but recovered under selective prediction (64% [95% CI: 54%-73%]). However, while selective prediction nearly maintains overall accuracy, our results suggest that it alters patterns of mistakes: when informed the AI abstains, clinicians underdiagnose (18% increase in missed diagnoses) and undertreat (35% increase in missed treatments) compared to no AI input at all. Our findings underscore the importance of empirically validating assumptions about how humans engage with AI within human-AI systems.

The need for explanations in AI has, by and large, been driven by the desire to increase the transparency of black-box machine learning models. However, such explanations, which focus on the internal mechanisms that lead to a specific output, are often unsuitable for non-experts. To facilitate a human-centered perspective on AI explanations, agents need to focus on individuals and their preferences as well as the context in which the explanations are given. This paper proposes a personalized approach to explanation, where the agent tailors the information provided to the user based on what is most likely pertinent to them. We propose a model of the agent's worldview that also serves as a personal and dynamic memory of its previous interactions with the same user, based on which the artificial agent can estimate what part of its knowledge is most likely new information to the user.

Artificial Intelligence (AI) systems are increasingly used for decision-making across domains, raising debates over the information and explanations they should provide. Most research on Explainable AI (XAI) has focused on feature-based explanations, with less attention on alternative styles. Personality traits like the Need for Cognition (NFC) can also lead to different decision-making outcomes among low and high NFC individuals. We investigated how presenting AI information (prediction, confidence, and accuracy) and different explanation styles (example-based, feature-based, rule-based, and counterfactual) affect accuracy, reliance on AI, and cognitive load in a loan application scenario. We also examined low and high NFC individuals' differences in prioritizing XAI interface elements (loan attributes, AI information, and explanations), accuracy, and cognitive load. Our findings show that high AI confidence significantly increases reliance on AI while reducing cognitive load. Feature-based explanations did not enhance accuracy compared to other conditions. Although counterfactual explanations were less understandable, they enhanced overall accuracy, increasing reliance on AI and reducing cognitive load when AI predictions were correct. Both low and high NFC individuals prioritized explanations after loan attributes, leaving AI information as the least important. However, we found no significant differences between low and high NFC groups in accuracy or cognitive load, raising questions about the role of personality traits in AI-assisted decision-making. These findings highlight the need for user-centric personalization in XAI interfaces, incorporating diverse explanation styles and exploring multiple personality traits and other user characteristics to optimize human-AI collaboration.

In this paper we propose an advanced approach to integrating artificial intelligence (AI) into healthcare: autonomous decision support. This approach allows the AI algorithm to act autonomously for a subset of patient cases whilst serving a supportive role in other subsets of patient cases based on defined delegation criteria. By leveraging the complementary strengths of both humans and AI, it aims to deliver greater overall performance than existing human-AI teaming models. It ensures safe handling of patient cases and potentially reduces clinician review time, whilst being mindful of AI tool limitations. After setting the approach within the context of current human-AI teaming models, we outline the delegation criteria and apply them to a specific AI-based tool used in histopathology. The potential impact of the approach and the regulatory requirements for its successful implementation are then discussed.

Trust biases how users rely on AI recommendations in AI-assisted decision-making tasks, with low and high levels of trust resulting in increased under- and over-reliance, respectively. We propose that AI assistants should adapt their behavior through trust-adaptive interventions to mitigate such inappropriate reliance. For instance, when user trust is low, providing an explanation can elicit more careful consideration of the assistant's advice by the user. In two decision-making scenarios -- laypeople answering science questions and doctors making medical diagnoses -- we find that providing supporting and counter-explanations during moments of low and high trust, respectively, yields up to 38% reduction in inappropriate reliance and 20% improvement in decision accuracy. We are similarly able to reduce over-reliance by adaptively inserting forced pauses to promote deliberation. Our results highlight how AI adaptation to user trust facilitates appropriate reliance, presenting exciting avenues for improving human-AI collaboration.

As the performance of artificial intelligence (AI) models improves, workflows in which human and AI model-based judgments are combined to make decisions are sought in medicine, finance, and other domains. Though statistical models often make more accurate predictions than human experts on average [Ægisdóttir et al., 2006, Grove et al., 2000, Meehl, 1954], whenever humans have access to additional information over the AI, there is potential to achieve complementary performance by pairing the two, i.e., better performance than either the human or AI alone. For example, a physician may have access to additional information that may not be captured in tabular electronic health records or other structured data [Alur et al., 2024b]. However, evidence of complementary performance between humans and AI is limited, with many studies showing that human-AI teams underperform an AI alone [Buçinca et al., 2020, Bussone et al., 2015, Green and Chen, 2019, Jacobs et al., 2021, Lai and Tan, 2019, Vaccaro and Waldo, 2019, Kononenko, 2001]. A solid understanding of such results is limited by the fact that most analyses of human-AI decision-making focus on ranking the performance of human-AI teams or each individually using measures like posthoc decision accuracy.

Despite the growing interest in human-AI decision making, experimental studies with domain experts remain rare, largely due to the complexity of working with domain experts and the challenges in setting up realistic experiments. In this work, we conduct an in-depth collaboration with radiologists in prostate cancer diagnosis based on MRI images. Building on existing tools for teaching prostate cancer diagnosis, we develop an interface and conduct two experiments to study how AI assistance and performance feedback shape the decision making of domain experts. In Study 1, clinicians were asked to provide an initial diagnosis (human), then view the AI's prediction, and subsequently finalize their decision (human-AI team). In Study 2 (after a memory wash-out period), the same participants first received aggregated performance statistics from Study 1, specifically their own performance, the AI's performance, and their human-AI team performance, and then directly viewed the AI's prediction before making their diagnosis (i.e., no independent initial diagnosis). These two workflows represent realistic ways that clinical AI tools might be used in practice, where the second study simulates a scenario where doctors can adjust their reliance and trust on AI based on prior performance feedback. Our findings show that, while human-AI teams consistently outperform humans alone, they still underperform the AI due to under-reliance, similar to prior studies with crowdworkers. Providing clinicians with performance feedback did not significantly improve the performance of human-AI teams, although showing AI decisions in advance nudges people to follow AI more. Meanwhile, we observe that the ensemble of human-AI teams can outperform AI alone, suggesting promising directions for human-AI collaboration.