Multi-Agent Retrieval Augmented Generation for Clinical Decision Support: A Systematic Review and Integrative Conceptual Framework
Abstract
Multi agent retrieval augmented generation (RAG) systems are increasingly explored as advanced architectures for clinical decision support combining information retrieval, reasoning and verification through coordinated agent interactions. This study systematically reviews applications of agentic and multi agent RAG in clinical decision support systems (CDSS) and synthesizes an integrative conceptual framework linking technical design to technology adoption considerations. Following PRISMA guidelines, searches were conducted from PubMed, IEEE Xplore and ScienceDirect using structured Boolean strings combining terms for multi agent architectures, RAG and CDSS.The search yielded 12 studies published between 2020 and 2025 that met the inclusion criteria. The review synthesises evidence on multi agent role configurations retrieval and reasoning strategies, verification mechanisms and reported clinical contexts. Across studies, dominant challenges include data and corpus limitations retrieval quality dependency, limited clinical validation and computational overhead, alongside governance concerns such as privacy, bias and accountability. Building on the synthesis, we propose a four-agent CDSS framework retriever, reasoner, verifier, safety and map its deployment determinants to Technology Acceptance Model constructs perceived usefulness, perceived ease of use, trust and diffusion of Innovations attributes. The review concludes with design-oriented recommendations for safer,…
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