Examining Introduction of E-consent in the Neurosurgical Caseload: Understanding the Barriers to Implementation.

ABSTRACT

OBJECTIVE: To evaluate current usage and barriers of electronic consent (e-consent) implementation in neurosurgical practice. E-consent forms provide an alternative method for conducting the informed consent (IC) procedure. IC requires an ability to understand, retain, weigh up, and communicate decisions regarding the proposed procedure. Currently, e-consent has shown promise as a method of improving IC, yet barriers to implementation exist. METHODS: A comparative analysis regarding procedural and consent data was collected over six months in 2 neurosurgical centers with elective and emergency caseloads. These were evaluated for changes over time following e-consent introduction. Clinicians were surveyed for their experience using of e-consenting to understand the barriers to implementation. RESULTS: Over one half (55.6%) of neurosurgical procedures made use of e-consent for IC. Lower rates of e-consent were used in trauma related procedures (38.38%) as compared to elective procedures. This did not increase significantly over the study period. Positive clinician survey feedback indicated e-consenting reduces the time required to perform IC, with 50% of respondents strongly agreeing. Barriers to implementation were reported on free-text entry pertaining largely to difficulties in emergency situations due to form complexity. The inability to create and edit templates for personalized e-consent delivery was a further limitation. CONCLUSIONS: Despite the advantages conferred by e-consent for the administration of IC in neurosurgical procedures, reflected in our survey data, there remains limited use of the technology. Limitations remain relating to ease of access and complexity of use in trauma scenarios.