Evaluating patient and caregiver satisfaction on the informed consent for surgery in a tertiary care center: a...

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.

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

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.

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).

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.