Innovations from the pandemic :Electronic consent and video appointments

 

The latest online event produced by the Progress Educational Trust (PET) gathered a cross-section of fertility professionals working at fertility clinics pre- and post-pandemic. The speakers reviewed and reflected on the changes that occurred in fertility clinics due to the pandemic, and whether such approaches are still proving useful now. 

 

Sarah Norcross, director of PET, began by casting our minds back to the pandemic's beginning, when clinics were compulsorily closed and then permitted to apply to reopen (see BioNews 1046), with new protocols to protect patients and staff. Norcross said that necessity was the mother of invention, when describing how the pandemic catalysed innovation. 

 

The first speaker, Dr Ashleigh Holt-Kentwell (clinical research fellow at Aberdeen Fertility Centre), offered valuable insights into the adoption and benefits of e-consents in fertility clinics, acknowledging the steep learning curve required to get to this stage. The pandemic certainly boosted uptake across the sector, enabled by an update for e-consenting issued by the Human Fertilisation and Embryology Authority (HFEA) in 2019. She explained the importance of consent for ensuring legal parenthood, and also for ensuring that embryos and gametes of patients are used and stored in accordance with the relevant patients' wishes. 

 

A clear benefit was that patients were able to access content from anywhere, and on multiple devices. Other benefits included sharing of consents in video appointments, direct storage via electronic notes and paperless systems, quality assurance due to multifactor authentication, picking up mismatches between partner consents for embryo storage and training, and personalisation of in-house consent forms. Howeverm Dr Holt-Kentwell also highlighted challenges, such as restrictions to the English language format. Time is required to check for errors, which cannot be corrected without a reissue of a form to be completed again. 

 

Ciara Heatherwick (a specialist nurse involved in preimplantation genetic testing at Glasgow Royal Infirmary's Assisted Conception Service) echoed the benefits and challenges of e-consents. She also noted the need for research into health literacy for e-consenting, notwithstanding the availability of videos and learning modules for patients on some platforms. Heatherwick shared her views on virtual appointments, explaining that while these can be more convenient and reduce the need for travel, issues including poor IT, connectivity problems and patient distractions during video appointments have led to a preference for face-to-face appointments among her nursing team. 

 

Alison Elliot and Lesley Benzie (fertility counsellors at Glasgow Royal Infirmary's Fertility Counselling Service) said that pandemic-induced changes in their services have created greater accessibility and flexibility - not just because of virtual appointments, but also because of streamlining processes and remote working. 

 

The distress arising from clinic closures and subsequent prioritisation of treatment resulted in an increased workload, which Elliot and Benzie were able to accommodate. Their experience during the pandemic led to the creation of a leaflet for online etiquette to share with patients before appointments, to encourage a professional setting during sessions. Issues around safeguarding, privacy and security for virtual appointments were also raised. The Fertility Counselling Service in Glasgow is now hybrid, so appointments can be offered in person if preferred or for more complex cases. 

 

George Hughes (lead clinical embryologist at Ninewells Hospital's Assisted Conception Unit), presented data investigating how e-consenting affects patients' consent choices for allowing their unused or unsuitable gametes and embryos to be used in the clinical training of laboratory staff. 

 

An audit demonstrated a significant drop in patients' consent to training on HFEA forms, when moving from paper to e-consenting. This drop was somewhat ameliorated after new HFEA forms were introduced, which included more information about clinical training. Hughes said that the current consents are overwhelming for patients, and there is difficulty in finding a balance of sufficient information to support informed consent. 

 

The last speaker, Dave Wales (quality manager at the Edinburgh Fertility Centre) was part of a group of assisted conception unit leads that assembled during the pandemic to find solutions for clinics to reopen safely. This was achieved by resolving challenges and sharing best practice with a safety-first approach, while limiting the impact on NHS services. One such solution was a video-based consulting tool, which patients still use to reduce travel and time off work. However, Wales also advocated for patient choice for video or face-to-face appointments. 

 

The Q&A session that followed the speaker presentations suggested that there is still room for improvement in e-consenting, and that research is required to understand the balance of information that should be given alongside forms. All speakers agreed that e-consenting does not necessarily save clinic time, due to the need to review, check and request that forms are reissued if there are errors. It was generally agreed that should another pandemic arise, clinics would be more prepared. In that situation, however, further innovation might be needed to address challenges involving blood test and scan appointments.