Explainable AI in Clinical Decision Support Systems: A Meta-Analysis of Methods, Applications, and Usability Challenges

Background: Theintegration of artificial intelligence (AI) into clinical decision support systems (CDSSs) has significantly enhanced diagnostic precision, risk stratification, and treatment planning. AI models remain a barrier to clinical adoption, emphasizing the critical role of explainable AI (XAI). Methods: This systematic meta-analysis synthesizes findings from 62 peer-reviewed studies published between 2018 and 2025, examining the use of XAI methods within CDSSs across various clinical domains, including radiology, oncology, neurology, and critical care. Model-agnostic techniques such as visualization models like Gradient-weighted Class Activation Mapping (Grad-CAM) and attention mechanisms dominated in imaging and sequential data tasks. Results: However, there are still gaps in user-friendly evaluation, methodological transparency, and ethical issues, as seen by the absence of research that evaluated explanation fidelity, clinician trust, or usability in real-world settings. In order to enable responsible AI implementation in healthcare, our analysis emphasizes the necessity of longitudinal clinical validation, participatory system design, and uniform interpretability measures. Conclusions: This review offers a thorough analysis of the state of XAI practices in CDSSs today, identifies methodological and practical issues, and suggests a path forward for AI solutions that are open, moral, and clinically relevant.