Article Text

Download PDFPDF
Original research
Legal authorized representative experience with smartphone-based electronic informed consent in an acute stroke trial
  1. Diogo C Haussen,
  2. Leah Craft,
  3. Shannon Doppelheuer,
  4. Gabriel Martins Rodrigues,
  5. Alhamza R Al-Bayati,
  6. Krishnan Ravindran,
  7. Meagan Schultz,
  8. Loretta Sutherly,
  9. Kiva M Schindler,
  10. Michael R Frankel,
  11. Raul G Nogueira
  1. Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
  1. Correspondence to Dr. Raul G Nogueira, Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, GA 30303, USA; raul.g.nogueira{at}


Background The pilot use of a smartphone platform for electronic informed consent (e-Consent) in large vessel occlusion acute stroke (LVOS) trials has recently been reported. The degree of satisfaction from Legal Authorized Representatives (LARs) with regard to this process remains to be established.

Methods A single-center study evaluating the experience of LARs with the use of e-Consent in a LVOS randomized trial of an investigational drug administered within 12 hours of last known normal was carried out. A structured survey was used to evaluate the experience of the LARs with the e-consenting process.

Results From February to November 2018, 60 consecutive patients were e-Consented. Of these, 53 LARs completed the survey. The median (IQR) age of the patients was 63 (53–70) years, baseline/discharge National Institutes of Health Stroke Scale score was 17 (12–20)/3(1–12), and 45% were independent at discharge. The survey was applied in person in 43% of cases and via telephone in 57%. Median LAR age was 48 (39–59) years, 64% were female, and a multi-ethnic composition was observed. Forty percent of LARs had less than tertiary level of education (high-school or less). Regarding the e-Consent, 98% of LARs reported to be ‘clear’ and 83% felt ‘very comfortable’ in signing. The overall experience was ‘excellent/good’ in 91%. Despite the positive general impression regarding the use of e-Consent, 12 LARs (22%) would have preferred paper consent. Multivariable regression indicated that lower educational status (tertiary education or less: OR 5.09, 95% CI 1.02 to 25.48; p=0.04) and lower baseline ASPECTS score (OR 0.63, 95% CI 0.41 to 0.96; p=0.03) were independently associated with preference for paper consent.

Conclusions e-Consent was overall very well perceived by LARs in a randomized clinical trial of LVOS. A minority of proxies, who were more commonly less formally educated, would have preferred paper consenting.

  • stroke
  • thrombectomy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors DCH: Study conception, design of the work, acquisition of data, statistical analysis, interpretation of data, drafting of the manuscript. LC, SD, GMR, ARA, MS, LS, KMS, MRF: Data acquisition, critical revision of manuscript. KR: Statistical analysis, critical revision of manuscript. RN: Design of the work, interpretation of data, critical revision of manuscript. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DCH: Consultant for Stryker and Vesalio; Viz-AI: stock options. RN: Principal Investigator, Stryker Neurovascular (DAWN trial - no compensation, Trevo-2 trial), Cerenovus/Neuravi (ENDOLOW trial - no compensation); consultant to Stryker Neurovascular; steering committee member, Stryker Neurovascular (no compensation), Medtronic (SWIFT trial, SWIFT Prime trial - no compensation), Cerenovus/Neuravi (ARISE-2 trial - no compensation); angiographic core lab, Medtronic (STAR trial); executive committee member, Penumbra (no compensation); physician advisory board, Cerenovus/Neuravi, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Allm Inc.(no compensation), Viz-AI; stock options, Viz-AI.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The unpublished data from this dataset are held by Grady Memorial Hospital/Emory University and DCH/RN. Requests for data sharing would be required to be discussed with them directly.

  • Patient consent for publication Not required.