Patients’ Understanding in the Surgical Informed Consent Process

Background

The Israeli Patient Rights Law mandates informed consent before surgery. However, prior studies suggest that the process is often suboptimal, with barriers affecting patients’ ability to understand and process the information provided.

Objectives

To examine patients’ understanding after the informed consent encounter and its alignment with postoperative experience, focusing on comparisons between central and peripheral hospitals and between the public and private sectors.

Methods

A cohort study was conducted in seven medical centers across Israel using two telephone interviews. The first, several days before surgery, assessed technical elements of informed consent and patient understanding. The second, about one month after surgery, examined concordance between preoperative explanations and postoperative experience.

Results

Most patients reported not receiving information about treatment alternatives (69%) or possible complications (64%). One-third did not recall the surgical approach explained, and about 45% received no information about the expected scar. In contrast, operational information was more frequently provided, including length of hospitalization (83%), surgery duration (65%), and recovery time (64%). Satisfaction with the physician was high: 90% reported clear explanations, 91% had an opportunity to ask questions, and 95% felt the physician was patient and attentive. Yet understanding of the consent form was lower (67%), and only 74% felt they had signed with full knowledge. Over 93% reporting clear explanations and attentiveness, and 91% stating that the surgery proceeded as described. Comparative analyses will be presented at the conference.

Conclusions

A meaningful gap exists between clinical and operational content in informed consent. Explanations about risks, alternatives, and core clinical aspects should be strengthened through standardized content, clearer materials, and protected time for questions.

Key messages

• Surgical informed consent provided stronger operational than clinical explanations, especially regarding risks, alternatives, and surgical details.

• High satisfaction with physicians did not fully translate into informed understanding, highlighting the need to strengthen consent quality.