Luitel Prajjwol, Paudel Sujan, Neupane Nischal, Shah Abhishek Kumar, Upadhya Pawan Sapkota, Thapa Anup
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Ann Med Surg (Lond). 2025 Jun 10;87(8):4897-4902. doi: 10.1097/MS9.0000000000003457. eCollection 2025 Aug.
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 -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 ( = 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.
手术知情同意（IC）流程对于尊重患者自主权以及保护患者和医护人员至关重要。然而，在包括尼泊尔在内的许多低收入和中等收入国家，IC往往被视为一种形式，患者参与有限，且常常依赖照护者主导的同意。文化规范、沟通不畅以及缺乏标准化协议导致了误解和不满。
评估患者和照护者对手术IC流程的满意度。
这项横断面研究在一家政府三级教学医院进行。研究纳入了368名连续接受各外科科室大型择期手术的尼泊尔语患者。收集了人口统计学数据，并使用一份经过预测试的结构化问卷来评估患者和照护者的满意度及理解情况。计算了描述性统计数据（频率、百分比、均值、标准差）。使用t检验或单因素方差分析进行比较分析。对于非正态分布变量，应用斯皮尔曼相关性分析。采用回归分析来确定影响患者和照护者满意度的因素。
总体而言，86.4%的患者和90.8%的照护者对IC流程感到满意。与患者相比，照护者对手术的性质（95.1%对88%）、适应症（98.9%对82.1%）以及潜在并发症（87.5%对68.5%）的理解明显更高。接受过小学及以上教育的患者的满意度得分显著高于文盲患者（P = 0.019；95%置信区间：0.16 - 2.61）。
尽管患者在IC流程中的参与有限，但患者和照护者均报告了较高的满意度，这表明尼泊尔医院中照护者主导的同意在文化上是被接受的。
