Comparative effectiveness of econsent: systematic review

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Cohen, E, Byrom, B, Becher, A, Jörntén-Karlsson, M and Mackenzie, AK ORCID: https://orcid.org/0000-0002-6818-2838, 2023. Comparative effectiveness of econsent: systematic review. Journal of Medical Internet Research, 25: e43883. ISSN 1439-4456

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Official URL: https://doi.org/10.2196/43883

Abstract

Background: Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns.

Objective: This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process (“cycle time”) and on-site workload in comparison with traditional paper-based consenting.

Methods: The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having “high” validity if comprehensive assessments were performed using established instruments.

Results: Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57% of the studies; 10 with “high” validity), acceptability (8/35, 23% of the studies; 1 with “high” validity), and usability (5/35, 14% of the studies; 1 with “high” validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the “high” validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent.

Conclusions: This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes.

Item Type:	Journal article
Publication Title:	Journal of Medical Internet Research
Creators:	Cohen, E., Byrom, B., Becher, A., Jörntén-Karlsson, M. and Mackenzie, A.K.
Publisher:	JMIR Publications Inc.
Date:	1 September 2023
Volume:	25
ISSN:	1439-4456
Identifiers:	Number Type 10.2196/43883 DOI 1875500 Other 37656499 PubMed ID
Rights:	© Edwin Cohen, Bill Byrom, Anja Becher, Magnus Jörntén-Karlsson, Andrew K. Mackenzie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
Divisions:	Schools > School of Social Sciences
Record created by:	Jonathan Gallacher
Date Added:	20 Mar 2024 11:00
Last Modified:	20 Mar 2024 11:02
URI:	https://irep.ntu.ac.uk/id/eprint/51127