Surgery & Anesthesia

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Surgeon: What the operation involves, its likely benefits and risks, and other options.
• Anesthesiologist or anesthetist: Anesthesia choices, worries about going under, and pain relief afterward.
• Perioperative nurse: Preparation, the day of surgery, and requests around the operation.
• Geriatric or palliative care team: Goals and what matters for older or seriously ill people, where such teams exist.
• Social worker: Help at home, costs and recovery plans.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A purposive sample chosen for contrast, not a ranking or a representative survey: Global, Tanzania, Nepal, Brazil, New Zealand, Australia, United Kingdom, Saudi Arabia, United States, Taiwan. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

• Global · Policy · 2015

  In resolution WHA68.15, adopted in May 2015, the World Health Assembly urged Member States to develop methods and financing systems making quality, safe, effective and affordable emergency and essential surgery and anesthesia accessible to all who need them.

  What others could learn: Cost, distance and referral can decide whether a person has surgery at all. A conversation about whether to have surgery can include who pays, how far the person must travel and what referral involves, since the resolution links access to financing, primary care and timely referral.

  Conditions, limits and source

  Conditions that matter:

  The resolution names national financing, a skilled surgical and anesthesia workforce (with task-sharing where appropriate), equipment and supplies, infection prevention, essential medicines including controlled medicines, and data on procedures, referrals and perioperative mortality.

  Cannot be inferred:

  Does not show how many people can reach affordable surgery today. Does not describe any country's services or laws. Says nothing about what a person should choose about their own surgery.

  Limits:

  A resolution adopted by Member States in 2015, not evidence that any country acted on it or that surgery became affordable. It does not address consent, patient preferences or how individual decisions about surgery are made. The IRIS issue date (2015-12-31) is a cataloguing date; the text is dated 26 May 2015. Progress reports requested for 2017 were not reviewed.

  Source: World Health Organization (Sixty-eighth World Health Assembly), Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage (Resolution WHA68.15, operative paragraph 1(1), PDF p. 4 (agenda item 17.1; adopted at the ninth plenary meeting, 26 May 2015)). Where: Global. Population: Everyone who needs emergency and essential surgical care and anesthesia; the resolution is addressed to WHO Member States. Published 2015-05-26; retrieved 2026-10-12.

• Tanzania · Reported experience · 2025

  Many of 14 patients interviewed after elective surgery at one tertiary teaching hospital in Dar es Salaam, Tanzania, felt the consent information was insufficient, superficial and difficult to understand, despite higher education levels.

  What others could learn: Patients wanted more on risks, aftercare, recovery and effects on daily life, in plain words rather than jargon. Some wanted to hear information alone and decide whom to tell; others wanted a family member present to help them understand and support recovery. Asking which the person prefers covers both.

  Conditions, limits and source

  Conditions that matter:

  Time in clinic, chances to ask questions, and separate anesthesia and procedure consent handled by different team members. The authors suggest trained interpreters or visual aids may help people with lower health literacy; the study did not test this.

  Cannot be inferred:

  Not representative of patients in Tanzania, including those in public or rural hospitals. Does not measure understanding. Does not show that any change to the consent process improves understanding.

  Limits:

  Single hospital and small sample (14), all with university education. People who could not speak English or Swahili were excluded, so the study says nothing about consent through interpreters. Interviews took place after surgery, at discharge. The authors work at the study institution.

  Source: SAGE Open Medicine (Michael S, Kyejo W, Ismail A, et al.), Patients' perceptions and understanding of preoperative informed consent: A qualitative thematic analysis from Tanzania. (Abstract, Results; full text (PMC12038201) sections on study participants, preferences for who is present, insufficient information and Limitations). Where: Tanzania (Dar es Salaam, one hospital). Population: Fourteen adults aged 27 to 69 after elective general, obstetric or gynecologic surgery; all had university education; English or Kiswahili speakers. Published 2025-04-28; retrieved 2026-10-12. Source in English; summarized from our own translation, not an official one.

• Nepal · Measured outcome · 2023

  In a 2022 survey of 350 major-surgery patients at one military hospital in Nepal, the authors report most did not know who would operate, the alternatives, the benefits, or the outcome of no treatment.

  What others could learn: All 350 forms were in the patient's native language and 95.4% of respondents said the form was understandable, yet most lacked key content. A readable form does not show understanding; asking the person to say back the plan, the alternatives and the outcome without surgery could reveal gaps. A relative alone signed 46.0% of forms.

  Conditions, limits and source

  Conditions that matter:

  Forms in the native language, usually given some hours before surgery; 76.3% said they had adequate time to decide. Military coverage of costs removes a financial barrier present in many other settings.

  Cannot be inferred:

  Not representative of Nepal or of civilian hospitals. Does not show why relatives signed or whether patients wanted them to. Does not test any improved consent form.

  Limits:

  Single military hospital with total population sampling; the authors say results may not generalize and that information bias was likely in a military setting. Full-text Tables 3 and 4 give different shares told the benefits of surgery (60.9% and 10.9%), which the paper does not explain. Answers are self-reported.

  Source: PLoS One (Basukala S, Shrestha O, Thapa N, et al.), How informed is informed consent?-Evaluating the quality of informed consent among surgical patients in a tertiary care hospital in Nepal. (Abstract, Results; full text (PMC10332608) Table 2 (form in native language; who signed it), Tables 3 and 4, and Limitations). Where: Nepal (one military hospital; author affiliations in Kathmandu). Population: 350 adults (mean age 48) having elective or emergency major surgery; serving soldiers, their families and other beneficiary groups. Published 2023-07-10; retrieved 2026-10-12.

• Brazil · Measured outcome · 2017

  In 2014, among 600 people diagnosed with cataract by a mobile unit in 13 São Paulo State municipalities, the abstract names older age, distance, small municipalities and fewer eye services as barriers, from municipal-level data.

  What others could learn: Free treatment and transport were not enough on their own: the public system covered treatment costs and municipalities provided transport on appointment days, yet fewer than half presented. Of 56 who did not have surgery, 9 refused and 17 were lost to follow-up. Asking what stands between the person and the hospital may matter even where surgery is free.

  Conditions, limits and source

  Conditions that matter:

  A universal public health system (SUS) covering treatment; municipal transport on appointment days; average distances of roughly 74 to 83 km to the referral hospital in the groups compared.

  Cannot be inferred:

  Does not give individual reasons for not attending. Not representative of Brazil. Does not show that removing these barriers raises uptake.

  Limits:

  Only 254 of 600 (42.3%) presented to the referral hospital. The full text says barriers were not analyzed individually; they rest on municipal-level data, and non-attendance was also associated with higher municipal HDI and per capita income, which the abstract does not mention. One region, one year (2014).

  Source: BMC Ophthalmology (de Almeida Ferreira G, Schaal LF, Ferro MD, et al.), Outcomes of and barriers to cataract surgery in Sao Paulo State, Brazil. (Abstract, Conclusion; full text (PMC5741937) Methods on SUS coverage and transport, Results on non-attendance, and Discussion on limitations). Where: Brazil (13 municipalities, southwest São Paulo State). Population: 600 people diagnosed with cataract (mean age 68.8; 62.3% women) at community screening by an ophthalmic mobile unit. Published 2017-12-22; retrieved 2026-10-12.

• New Zealand · Measured outcome · 2026

  Of 173 Asian surgical patients with documented definite limited English proficiency at Waikato Hospital, New Zealand, in 2022 and 2023, 37 (21.4%) received no interpreter; none of 14 with suspected limited proficiency received one.

  What others could learn: Recording the person's preferred language and need for an interpreter before consent, and acting on suspected as well as documented need, addresses the gap the abstract describes. Indian patients with definite limited proficiency were less likely to receive interpreters than other Asian patients.

  Conditions, limits and source

  Conditions that matter:

  Interpreter availability, clinician training and documentation of language need. The authors call for compliance with national guidelines, which the abstract does not name. Patients with definite limited proficiency were older on average (65.4 years) than proficient patients (47.4).

  Cannot be inferred:

  Does not show that consent without an interpreter was invalid or that outcomes differed. Not representative of New Zealand hospitals or of non-Asian patients with limited English proficiency.

  Limits:

  Abstract only; the journal site and doi.org were unreachable. Single hospital. English proficiency was classified from clinical documentation, so need may be missed or misrecorded. The abstract does not say how interpreters were provided or whether family members interpreted instead.

  Source: New Zealand Medical Journal (Richly P, Turnwald S, Menkes D); abstract via PubMed, Interpreter use during surgical consent for Asian patients with limited English proficiency. (Abstract, Results (N Z Med J 2026;139(1635):50-56)). Where: New Zealand (Waikato Hospital, Hamilton). Population: 540 Asian patients who had surgical procedures in 2022 and 2023; 173 documented as definite and 14 as suspected limited English proficiency. Published 2026-05-29; retrieved 2026-10-12.

• Australia · Service in operation · 2018

  In urban South East Queensland, Australia, an Indigenous primary health care organization and community stakeholders mapped and redesigned the cataract surgery pathway to reduce the number of patients removed by the system at key transition points.

  What others could learn: Bringing eye health into the primary care clinic people already use improved continuity and coordination along the surgical pathway, per the abstract. A surgical conversation can ask which steps (referral, appointments, travel, follow-up) are hardest for the person, since those transition points are where people drop out.

  Conditions, limits and source

  Conditions that matter:

  An Indigenous primary health care organization integrating eye health into its clinics, community stakeholders involved in the redesign, and lasting partnerships with external organizations that provide surgery.

  Cannot be inferred:

  Does not show better visual outcomes, only increased use of services. Does not show that the model works for other surgical pathways or communities, which the authors propose but did not test.

  Limits:

  Abstract only; the publisher site and doi.org were unreachable. Two authors are affiliated with the organization that ran the redesign. The abstract reports a significant increase in use of cataract surgical services from audit data but gives no numbers, comparison group or visual outcomes. Published 2018; current operation not verified.

  Source: Australian Journal of Primary Health (Penrose L, Roe Y, Johnson NA, James EL); abstract via PubMed, Process redesign of a surgical pathway improves access to cataract surgery for Aboriginal and Torres Strait Islander people in South East Queensland. (Abstract (Aust J Prim Health 2018;24(2):135-140)). Where: Australia (urban South East Queensland). Population: Aboriginal and Torres Strait Islander people needing cataract surgery. Published 2018-05; retrieved 2026-10-12.

• United Kingdom · Reported experience · 2023

  A UK study of preoperative consultations with older high-risk patients at five hospitals found decisions about major surgery were not always shared; the presenting problem, comorbidities, pathway and patient trajectory shaped opportunities to share them.

  What others could learn: Patients facing a life-threatening problem often wanted it fixed and accepted the decision. Where surgery was questioned because of other illnesses, consultations were framed around what mattered to the patient, weighing risk of death, long-term care needs and the chance of living independently, with relatives taking part.

  Conditions, limits and source

  Conditions that matter:

  Time for discussion, often across several consultations; clinical pathways that bring the decision late; the type of presenting problem. Anesthetists and colorectal surgeons noted the time such discussions need.

  Cannot be inferred:

  Does not show that shared decisions change outcomes or regret. Does not measure how often decisions were shared. Health literacy and ethnicity were not measured.

  Limits:

  Small patient sample, as the authors note. Focus groups included neither orthopedic nor cardiac surgeons. High-risk status was identified with a comorbidity index plus clinician judgment. The authors note limits on transfer to other health systems. A published letter commenting on the article was not reviewed.

  Source: British Journal of Anaesthesia (Shaw SE, Hughes G, Pearse R, et al.), Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study. (Abstract, Conclusions; full text (PMC10308437) Results on deliberative consultations, Discussion, and Strengths and limitations). Where: United Kingdom (five hospitals). Population: Older high-risk patients offered major orthopedic, colorectal or cardiac surgery: 33 patients, 19 relatives and 36 clinicians. Published 2023-04-26; retrieved 2026-10-12.

• Saudi Arabia · Measured outcome · 2016

  Of 400 adults surveyed at pre-anesthesia clinics of three tertiary hospitals in Riyadh, Saudi Arabia, 88% reported preoperative fear; the most common fears concerned postoperative pain, awareness during surgery and sleepiness afterward.

  What others could learn: Asking the person what worries them most about anesthesia, rather than assuming, lets the team answer that worry. Women and people over 40 reported more fear. The authors suggest building rapport between patient and anesthesiologist in the pre-anesthesia clinic.

  Conditions, limits and source

  Conditions that matter:

  A pre-anesthesia clinic visit before surgery with time for questions; an Arabic-language questionnaire.

  Cannot be inferred:

  Does not show that discussing fears reduces anxiety or changes outcomes. Not representative of Saudi Arabia. Does not explain why fear differed by sex or age.

  Limits:

  Data from 2013. The abstract gives 88% for overall fear and the full text 88.9%; the abstract's fear of being sleepy appears in the full text as delayed recovery of consciousness. People with communication problems were excluded. Respondents rated a fixed list of fears, so other worries were not captured.

  Source: Saudi Journal of Anaesthesia (Ruhaiyem ME, Alshehri AA, Saade M, et al.), Fear of going under general anesthesia: A cross-sectional study. (Abstract, Results; full text (PMC4916817) Methods and Discussion). Where: Saudi Arabia (Riyadh, three tertiary hospitals). Population: 400 adults scheduled for minor or major surgery under general anesthesia; people with communication problems or a psychiatric history were excluded. Published 2016-07; retrieved 2026-10-12. Source in English; summarized from our own translation, not an official one.

• United States · Measured outcome · 2021

  In a US survey of 236 people who had cancer-directed surgery, 49.6% wanted religious or spiritual resources when admitted to the hospital, such as a chance to speak with a religious or spiritual leader, texts or journaling materials.

  What others could learn: Irrespective of religious or spiritual identification, 68.0% did not want their physician to engage with them about these topics. Offering access to a chaplain or other religious or spiritual leader, texts or journaling materials, without the surgeon leading that conversation, fits both findings.

  Conditions, limits and source

  Conditions that matter:

  Chaplains or community religious and spiritual leaders who can visit, materials on the ward, and a way to ask about such requests on admission. Respondents who identified as religious wanted these resources built into care more often.

  Cannot be inferred:

  Does not show that offering resources improves experience or outcomes. Not representative of US surgical patients or of any religious group. Says nothing about what any tradition requires.

  Limits:

  Abstract only; the publisher site and doi.org were unreachable. Respondents were mostly white women. Recruitment site and response rate are not stated in the abstract. Preferences were asked after surgery, and the abstract does not report whether resources were offered or used.

  Source: Palliative and Supportive Care (Palmer Kelly E, Paredes AZ, DiFilippo S, et al.); abstract via PubMed, The religious/spiritual beliefs and needs of cancer survivors who underwent cancer-directed surgery. (Abstract, Results (Palliat Support Care 2021;19(2):175-181)). Where: United States (author affiliations in Columbus, Ohio). Population: 236 adults after cancer-directed surgery; mean age 58.8; 76.2% women; 94.1% white; 43.6% breast cancer survivors; 55.9% identified as religious, 27.9% as only spiritual and 16.2% as neither. Published 2021-04; retrieved 2026-10-12.

• Taiwan · Reported experience · 2016

  Twelve family members of adult elective surgery patients in Taiwan gave three reasons for joining surgical decisions: to share responsibility, to ensure medical information was correct, and to safeguard the patient's well-being.

  What others could learn: The authors report that culture was not the only reason for family involvement, and that a patient who feels unable to tell clinicians everything may expect family to speak up during consent. Asking the person whom they want involved, and in what role, avoids assuming either a family-led or a solo decision.

  Conditions, limits and source

  Conditions that matter:

  The stress of deciding about surgery, an imbalance of power between doctor and patient as the authors describe it, and family members' ability to attend consultations.

  Cannot be inferred:

  Does not show that family involvement helps or harms decisions. Not representative of Taiwan or of people of Chinese heritage elsewhere. Does not describe law on who may consent for a patient.

  Limits:

  Abstract only; the publisher site and doi.org were unreachable. Twelve family members; recruitment sites are not stated. Patients were not interviewed, so whether they wanted this involvement is not reported from their side.

  Source: Journal of Clinical Nursing (Lin ML, Huang CT, Chen CH); abstract via PubMed, Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study. (Abstract, Results and Conclusions (J Clin Nurs 2017;26(13-14):1969-1977)). Where: Taiwan. Population: Twelve family members of 12 adult elective surgery patients. Published 2016-12-18; retrieved 2026-10-12.

• The sourced examples include policy, reported experience, measured outcome, service in operation. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.