Patient Perspectives on Consent Following Hip Fracture: A Mixed-Methods Study

Informed consent in hip fracture patients remains challenging due to pain, analgesia effects, and psychological distress. In this multi-centre mixed-methods study we explored patients’ ability to retain information as well as their perceptions of the consent process. Patients with hip fractures completed structured questionnaires within 36-hours of admission assessing recall of risks. Seventeen patients underwent semi-structured interviews post-operatively. Thematic analysis followed grounded theory methodology. Forty patients with hip fractures (median age: 77 years, female: 73%, n=29/40) completed structured questionnaires. While 93% (n=37/40) reported satisfaction with consent and 90% (n=36/40) could describe their operation, unprompted risk recall was poor: death (28%, n=11/40), stroke/myocardial infarction (15%, n=6/40), infection (15%, n=6/40). Functional complications were least frequently documented on consent forms (limp 15% (n=6/40), chronic pain 43% (n=17/40), leg length discrepancy 50% (n=20/40) despite being patients’ primary concerns. Three themes emerged from interviews: (1) Loss of agency : patients viewed consent as formality with no reasonable alternative, stating “I had a broken hip…of course I was going to have it done”; (2) Personalised risk : functional outcomes carried greater significance than medical complications, with expectations shaped by prior experiences of family/friends; (3) Information timing : written materials were deemed unhelpful pre-operatively due to pain and distress but highly valued post-operatively for managing recovery expectations and addressing symptoms. Rather than viewing consent as unidirectional and knowledge as static and transferable, hip fracture patients interpret medical information in a fluid and contextual manner, which is co-constructed throughout their encounter with their surgical team.