Comparative Effectiveness of eConsent: Systematic Review (Preprint)

BACKGROUND Patients’ informed consent to participate is fundamental to ethical clinical research. Giving informed consent means agreeing to take part in the trial and having understood what is involved, including the risks and benefits of participation. 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 effects on time taken to consent (“cycle time”) and 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 studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as “high” if comprehensive assessments, such as established instruments, were used. RESULTS A total of 37 publications describing 35 studies (13,281 participants in total) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20 studies [10 with “high” validity]), acceptability (8 studies [1 with “high” validity]), and usability (5 studies [1 with “high” validity]) reported either significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. No study reported better results with paper than eConsent. Among “high” validity studies, six studies on comprehension reported significantly better understanding for 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 paper (all P<.05). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with 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.