Can Legal Witness Enhance Communication Quality? The Role of Lawyer Presence in Family Satisfaction with Surgical Risk Disclosure for Geriatric Hip Fracture

Background The management of osteoporotic hip fractures in the elderly carries high risks. The quality of preoperative informed consent directly impacts family satisfaction and the risk of medical disputes. Conventional communication models are variable, and the introduction of a third-party lawyer witness may optimize this process by enhancing the formality and comprehensiveness of the communication. Methods This single-center retrospective cohort study consecutively enrolled elderly hip fracture patients and their guardians who underwent surgery at Peking Union Medical College Hospital between June 2022 and June 2025. Participants were divided into a Lawyer-Present Group and a Usual Care Group based on the presence of a lawyer during the preoperative consent conversation. At 3 months postoperatively, a third-party administered survey assessed guardian satisfaction, anxiety changes, and the Decision Regret Scale (DRS) measured decision-related feelings. Intergroup comparisons were performed using Chi-square tests, t-tests, and effect size analyses. Results A total of 94 patient-guardian pairs completed follow-up. The proportion of guardians who were "Very satisfied" with the preoperative conversation was significantly higher in the Lawyer-Present Group than in the Usual Care Group (79.5% vs. 12.7%, p < .001), with a large effect size (Cramér's V = 0.672). The Lawyer-Present Group also scored significantly better on the sufficiency of information regarding surgical necessity, risks, and increased decision confidence (all p < .01). However, a higher proportion of guardians in this group reported "Greatly increased anxiety" (74.4% vs. 38.2%, p < .001). While overall DRS scores showed no significant difference, within the subgroup of patients who developed postoperative complications, guardians in the Usual Care Group exhibited significantly higher regret (40.63 ± 7.29 vs. 30.00 ± 3.54, p = .012), with a very large effect size (Cohen's d = 1.72). Conclusion The introduction of a lawyer witness during preoperative conversations significantly improved communication satisfaction and perceived information quality among guardians of elderly hip fracture patients. The associated increase in anxiety may reflect a deepening of risk perception. In cases of complications, lawyer presence was associated with reduced decision regret among guardians. This suggests that procedural legal witnessing could serve as a potentially effective tool to enhance the quality of informed consent for high-risk surgery and strengthen the resilience of the doctor-patient relationship.