Exploring alternative approaches to next of kin consenting in the semi-emergency neurosurgical scenario

Prior to any surgical intervention, obtaining informed consent is necessary. In situations where patients are unable to provide informed consent due to mental incapacity or reduced consciousness, the responsibility falls on surrogate decision-makers, typically family members. This predicament commonly arises during neurosurgical emergencies. Various types of surgical emergencies exist, each with its own classification. In cases of life-threatening neurosurgical emergencies and in the absence of next of kin, two consultants have the authority to decide and grant surgical consent. However, for urgent and semi-emergency surgical cases, obtaining consent from the next of kin is crucial. The conventional requirement for the physical presence of the next of kin at the hospital often causes delays in the procedure. This study aims to explore alternative methods for efficiently and compliantly securing this consent for urgent and semi-emergency neurosurgical cases.

A prospective, observational crosssectional survey was conducted from 1st May 2022 to 31st December 2022 at the University of Malaya Medical Centre, Kuala Lumpur. This survey included all neurosurgical patients aged 18 and above requiring urgent and semiemergency surgery. The next of kin were interviewed using a standardised questionnaire to obtain their perspectives on the effectiveness of the current consenting process, as well as to explore potential alternative methods for obtaining consent. Data were analysed using IBM SPSS Statistics.

The survey had 103 responses. The analysis revealed that the most common semi-emergency surgical procedures were craniotomy (22 cases) and external ventricular drain insertion (18 cases), followed by burr hole and drainage (14 cases). The most common primary diagnosis that needed urgent intervention was acute hydrocephalus. Interestingly, more than half of the patients (58 cases, 56.3%) had to wait for over 30 minutes to obtain consent from their next of kin prior to surgery. The next of kin interviewed had an age range of 25 to 72 years. The relationships of the next of kin were children (33 subjects), spouses (26 subjects), siblings (25 subjects), and parents (16 subjects) of the patients. Additionally, 96.1% of the respondents owned a smartphone with a mobile internet data connection, and 85.4% had internet connectivity at home. The most preferred method of telecommunication for this exercise was via WhatsApp. An interesting finding was the association between the level of trust in medical professionals and the preferred consent method. It was discovered that individuals who preferred physical consent had lower trust in the hospital and doctors, while those who preferred remote consent had higher trust.

The urban Malaysian population are ready to embrace telecommunication for next-of-kin consent in semiemergency neurosurgical scenarios. These findings form a precursor to further studies to develop algorithms for a secure remote digital surgical consenting platform for urgent or semi-emergency surgical cases.