Ethical Impact of Real-Time Surgical Communication on Family Perceptions of Transparency, Fairness, and Trust: A Prospective Study

Background Family members of surgical patients often face long periods of uncertainty during intraoperative waiting. Despite technological advances, real-time updates are rarely provided, raising ethical concerns about transparency, procedural fairness, and trust. This study aimed to evaluate the ethical impact of a structured, real-time information-sharing intervention on family members’ perceptions during surgery. Methods We conducted a prospective, single-center, randomized controlled trial at a tertiary hospital in China. Eligible family members of adult patients undergoing elective surgery were randomized to receive either structured intraoperative updates through a digital messaging system or standard postoperative communication. Primary outcomes included perceived medical transparency, procedural fairness (Health Care Justice Questionnaire), and trust in the surgical team, assessed immediately after surgery. Secondary outcomes included state anxiety and satisfaction with care. Analysis was performed using ANCOVA adjusted for baseline characteristics. Results A total of 268 participants were enrolled and analyzed (intervention: n = 134; control: n = 134). Compared to the control group, participants in the intervention group reported significantly higher levels of perceived transparency (mean score: 4.41 vs. 3.56, p  < 0.001), procedural fairness (4.33 vs. 3.62, p  < 0.001), and trust in the surgical team (4.49 vs. 3.91, p  = 0.002). The intervention group also experienced lower post-procedural anxiety (STAI score: 34.8 vs. 41.2, p  < 0.001) and higher satisfaction with communication. No adverse events were reported. Conclusions Structured real-time communication with surgical families significantly enhances their perceptions of ethical care, including transparency, fairness, and trust. These findings support the integration of intraoperative updates as an ethically grounded standard of perioperative practice. Trial registration Chinese Clinical Trial Registry, ChiCTR2300077983. Registered on October 25, 2023.