Analysis of the Interactive Relationships Between Barriers Affecting Patients' Informed Consent

Getting informed consent right isn't just a box to check. It's a vital part of building trust and ensuring the best possible care. When done well, it can make patients feel more confident and involved in their treatment, which often leads to better outcomes and higher satisfaction. The goal of this study was to thoroughly explore the challenges that stand in the way of obtaining informed consent from patients. It also sought to map out the complex connections between these barriers, shedding light on how they influence one another.

This study, conducted in early 2025, using a descriptive and analytical cross-sectional approach. It was carried out in two phases: a scoping review based on the Arksey and O'Malley framework and a quantitative phase using the DEMATEL method, which relies on expert judgments and pairwise comparisons to map causal relationships among factors. Data were collected via a researcher-made questionnaire from a purposively selected sample at a private hospital in Tehran, with analysis performed using SPSS, MATLAB, and EdrawMax software.

The barriers affecting informed satisfaction were categorized into seven communicative, economic, psychological, cultural and social, organizational, legal, ethical, and informational components. Also, communicative and psychological barriers were identified as the most influential and most affected factors, respectively.

Informed consent is a dynamic, system-driven process wherein communicative barriers act as primary drivers and psychological barriers as key outcomes. Theoretically, this supports causal, multi-level modeling of health communication; practically, it calls for clinician training, adaptable protocols, and policy reforms prioritizing patient comprehension and equity.