Current applications and challenges in large language models for patient care: a systematic review
Communications Medicine, vol. 5, pp. 26
Abstract
BACKGROUND: The introduction of large language models (LLMs) into clinical practice promises to improve patient education and empowerment, thereby personalizing medical care and broadening access to medical knowledge. Despite the popularity of LLMs, there is a significant gap in systematized information on their use in patient care. Therefore, this systematic review aims to synthesize current applications and limitations of LLMs in patient care. METHODS: We systematically searched 5 databases for qualitative, quantitative, and mixed methods articles on LLMs in patient care published between 2022 and 2023. From 4349 initial records, 89 studies across 29 medical specialties were included. Quality assessment was performed using the Mixed Methods Appraisal Tool 2018. A data-driven convergent synthesis approach was applied for thematic syntheses of LLM applications and limitations using free line-by-line coding in Dedoose. RESULTS: We show that most studies investigate Generative Pre-trained Transformers (GPT)-3.5 (53.2%, n = 66 of 124 different LLMs examined) and GPT-4 (26.6%, n = 33/124) in answering medical questions, followed by patient information generation, including medical text summarization or translation, and clinical documentation. Our analysis delineates two primary domains of LLM limitations: design and output. Design limitations include 6 second-order and 12 third-order codes, such as lack of medical domain optimization, data transparency, and accessibility issues, while output limitations include 9 second-order and 32 third-order codes, for example, non-reproducibility, non-comprehensiveness, incorrectness, unsafety, and bias. CONCLUSIONS: This review systematically maps LLM applications and limitations in patient care, providing a foundational framework and taxonomy for their implementation and evaluation in healthcare settings.
Authors 14
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Felix Busch corresponding
TUM Klinikum · Technical University of Munich
Affiliation as printed
School of Medicine and Health, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM University Hospital, Technical University of Munich, Munich, Germany. felix.busch@tum.de
School of Medicine and Health, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM University Hospital, Technical University of Munich, Munich, Germany
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Humboldt-Universität zu Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Humboldt-Universität zu Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Leiden University Medical Center · Sir Charles Gairdner Hospital
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
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Affiliation as printed
Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Affiliation as printed
One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito, Ecuador
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TUM Klinikum · Technical University of Munich
Affiliation as printed
School of Medicine and Health, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM University Hospital, Technical University of Munich, Munich, Germany
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Azienda Ospedaliero-Universitaria Cagliari
Affiliation as printed
Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
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Deutsches Herzzentrum München · Technical University of Munich
Affiliation as printed
School of Medicine and Health, Institute for Cardiovascular Radiology and Nuclear Medicine, German Heart Center Munich, TUM University Hospital, Technical University of Munich, Munich, Germany
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Heidelberg University · University Hospital Heidelberg · National Center for Tumor Diseases · Else Kröner Fresenius Center for Digital Health · Technische Universität Dresden
Affiliation as printed
Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Affiliation as printed
Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
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Affiliation as printed
Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
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TUM Klinikum · Technical University of Munich
Affiliation as printed
School of Medicine and Health, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM University Hospital, Technical University of Munich, Munich, Germany
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TUM Klinikum · Deutsches Herzzentrum München · Technical University of Munich
Affiliation as printed
School of Medicine and Health, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM University Hospital, Technical University of Munich, Munich, Germany
School of Medicine and Health, Institute for Cardiovascular Radiology and Nuclear Medicine, German Heart Center Munich, TUM University Hospital, Technical University of Munich, Munich, Germany
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