Patient-Reported Perceptions of Surgical Informed Consent Communication in Elective General Surgery: A...

Informed consent supports voluntary surgical decision-making, yet patients' routine perceptions of consent communication remain insufficiently described. In China, where family involvement and time-pressured care are common, understanding how patients retrospectively perceive written and oral consent communication is important.

We conducted a cross-sectional survey of 627 consecutive adult patients undergoing elective general surgery in a tertiary general hospital in Fuzhou, Fujian Province, China. Participants were interviewed face-to-face on postoperative days 2-7 using a structured questionnaire adapted from a validated instrument. Items were categorical (dichotomous, ordinal, or single/multiple-response). The survey assessed postoperative reports of written consent form handling, perceived understanding, oral explanation content, and the influence of information on decision-making. Multivariable logistic regression examined factors associated with self-reported careful reading, perceived full understanding of the written form, and reported discussion of surgical alternatives and non-treatment consequences, adjusting for sociodemographic and consent-process variables.

Of 627 participants, 94.6% reported receiving a written consent form. Among recipients, self-reported careful reading (89.4%) and perceived full understanding (91.3%) were high, although 15.6% received the form only shortly before surgery and family involvement in signing was frequent. Most respondents also received oral explanations, commonly perceived as complete and understandable. Retrospectively, oral discussions focused on diagnosis (89.0%) and planned procedures (83.3%), whereas alternatives (27.7%) and non-treatment consequences (36.2%) were discussed less frequently. In multivariable models, explanation of the form at delivery was strongly associated with careful reading (adjusted odds ratio [aOR] 30.69, 95% CI 6.67-141.31, p<0.001) and perceived full understanding (aOR 41.55, 95% CI 4.77-361.55, p=0.001); college-level education was associated with reported discussion of alternatives (aOR 3.88, 95% CI 1.91-7.86, p<0.001) and non-treatment consequences (aOR 3.60, 95% CI 1.87-6.92, p<0.001), whereas receiving the form closer to surgery and from a non-surgeon were associated with lower odds of these disclosures. Several estimates had wide confidence intervals and should be interpreted cautiously.

Most postoperative patients reported receiving written and oral consent information and perceived both as understandable. However, alternatives and non-treatment consequences were reported less frequently, indicating gaps in the discussed information scope. These findings reflect retrospective, patient-reported perceptions of the consent process among clinically stable elective surgery patients, rather than objective understanding or an audit of overall informed consent quality.