Ethically Translating Advanced Neurotechnologies for Disorders of Consciousness: A Survey of Clinicians' Perspectives

Although evaluation of disorders of consciousness (DoC) following brain injury has traditionally relied on bedside behavioral examination, advances in neurotechnology have elucidated novel approaches to detecting and predicting recovery of consciousness. Professional society guidelines now recommend that clinicians integrate these neurotechnologies into clinical practice as part of multimodal evaluations for some patients with DoC but have not crafted concrete protocols for this translation. Little is known about the experiences and ethical perspectives held by key stakeholder groups around the clinical implementation of advanced neurotechnologies to detect and predict recovery of consciousness. Recognizing this knowledge gap, the Data-Driven Neuroethics for Consciousness Detection (DECODE) survey examined clinicians' perspectives on advanced neurotechnologies for DoC care, including access to and rates of adoption, perceived utility, facilitators and barriers to adoption in clinical settings, ethical considerations surrounding clinical implementation, and challenges encountered in ensuring care for patients with acute and prolonged DoC. Mixed-methods analysis including qualitative analysis, grounded theory methodology, and ethical analysis was employed to assess responses and key themes. Ninety-two clinicians consented to the survey. More than 70% believed that standard bedside behavioral examination is insufficient, and nearly 60% viewed advanced neurotechnologies as integral in optimal DoC evaluation. Training gaps and limited institutional infrastructure were identified as salient barriers to clinical implementation. Thematic analysis revealed concerns about the interpretation of results, impact on surrogates, and validity of test results. Ethical themes of prognostic uncertainty, nihilism, and access also permeated multiple domains. Considerations surrounding access, knowledge base, results interpretation, and communication with surrogates are cross-cutting ethical threads shaping the clinical translation of advanced neurotechnologies for DoC. These components represent opportunities for implementation science work focused on democratizing access to neurotechnologies, educating clinicians on the use of novel techniques and interpretation of results, conducting multisite validation studies, and standardizing approaches to communicating test results.