Evaluating patient and caregiver satisfaction on the informed consent for surgery in a tertiary care center: a cross-sectional study

Abstract

Introduction: The surgical informed consent (IC) process is essential for respecting patient autonomy and safeguarding patients and healthcare providers. However, in many low- and middle-income countries, including Nepal, IC is often treated as a formality, with limited patient involvement and frequent reliance on caregiver-led consent. Cultural norms, poor communication, and lack of standardized protocols contribute to misunderstandings and dissatisfaction.

Aim: To assess the satisfaction of patients and caregivers with the surgical IC process.

Methods: This cross-sectional study was conducted at a government tertiary-level teaching hospital. It included 368 consecutive Nepali-speaking patients undergoing major elective surgeries across surgical departments. Demographic data were collected, and a structured, pretested questionnaire was used to assess the satisfaction and understanding among patients and caregivers. Descriptive statistics (frequencies, percentages, means, SDs) were calculated. Comparative analyses were conducted using t-tests or one-way ANOVA. For non-normally distributed variables, Spearman's correlation was applied. Regression analysis was used to identify factors influencing patient and caregiver satisfaction.

Results: In total, 86.4% of patients and 90.8% of caregivers were satisfied with the IC process. Caregivers had a significantly higher understanding of the nature (95.1% vs. 88%), indication (98.9% vs. 82.1%), and potential complications of surgery (87.5% vs. 68.5%) compared to patients. Patients with primary education or higher had significantly higher satisfaction scores than illiterate patients (P = 0.019; 95% CI: 0.16-2.61).

Conclusion: Although patient participation in the IC process was limited, both patients and caregivers reported high satisfaction, suggesting cultural acceptance of caregiver-led consent in Nepalese hospitals.

Keywords: caregivers; informed consent; patient rights.

Figure 1.

Bar graph showing the information in the IC form.