A DEMATEL-based model to analyze causal factors affecting patients' informed consent

Patients' informed consent is recognized as a fundamental pillar of medical ethics and patient rights. Failure to acknowledge or adequately implement informed consent carries serious consequences for the integrity and effectiveness of the healthcare system. This study aims to analyze the systematic relationships among factors influencing patients' informed consent.

This descriptive-analytical cross-sectional study was conducted at a private hospital in Tehran in early 2025. A sample of 11 specialist physicians and nurses was selected using purposive and snowball sampling methods. Data were collected using a pairwise comparison matrix questionnaire. Descriptive data analysis was performed using SPSS 26.0, and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was applied using MATLAB software.

The results showed that in the interactive model and systematic relationship analysis among components influencing the obtaining of informed consent from patients, interpersonal and individual factors belong to the group of influential factors, while organizational and environmental fact ors belong to the group of influenced factors. Interpersonal and environmental factors were identified as the most influential and most influenced factors, respectively.

The DEMATEL-based model identified interpersonal and individual factors as key influencers of informed consent, while organizational and environmental factors were primarily influenced. This suggests that improving communication quality and patient understanding may generate system-wide benefits. However, findings reflect a single private hospital context and should be considered exploratory. The model provides a hypothesis-generating foundation for future validation and targeted interventions in similar Iranian healthcare settings.