RAG-Enhanced LLMs for Interactive Explainability in Clinical Decision Support Systems

Lorenzo Mannocci, Francesca Naretto, Lucia Passaro, Anna Monreale

Artificial Intelligence (AI) is increasingly embedded in high-risks decision-making systems across domains such as healthcare, finance, and the judicial system. As reliance on predictive models grows, so does the demand for Explainable AI (XAI) to ensure transparency, trust, and interpretability. However, existing XAI approaches often fail to present explanations in a format accessible to domain experts, limiting their practical utility. Large Language Models (LLMs) have recently emerged as a bridge between complex models and end-users, offering natural language explanations. Yet, their use introduces new risks, including hallucinated outputs and lack of source traceability. To address these challenges, we propose a Clinical Decision Support System (CDSS) that not only combines standard predictive models with XAI techniques but also incorporates a Retrieval-Augmented Generation module as an interactive enhancer. This module grounds explanations in verified medical knowledge, reformulates technical outputs into a human-like format, and enables users-such as clinicians-to actively query the system. By fostering an interactive, human-in-the-loop environment, our approach empowers…