Bridging patient and clinician perspectives on orthodontic informed consent: practical guidance for contemporary clinical practice

Informed consent (IC) is a fundamental requirement in healthcare, grounded in legal obligations and ethical respect for patient autonomy. In orthodontics, IC is particularly important because of the prolonged and largely elective nature of treatment, its multi-stage delivery, and the frequent need to modify treatment plans as care progresses. Medico-legal literature in orthodontics suggests that disputes arise more commonly from deficiencies in the consent process than from technical or clinical errors alone, highlighting IC as a critical safeguard in risk management. In Malaysia, orthodontic IC is primarily guided by general professional standards, with limited orthodontic-specific guidance available. Furthermore, existing literature has largely examined IC from a single perspective, either that of patients or clinicians, revealing a gap in studies integrating both perspectives. This qualitative case study explored the perspectives of clinicians and patients regarding orthodontic IC. Data were collected through semi-structured in-depth interviews with six clinicians (residents) and twelve patient participants (eleven patients and one parent), twelve non-participant observations of informed consent process (ICP) sessions, and a document review. Data were managed using NVivo 15 software and analysed thematically using a hybrid deductive–inductive approach guided by an initial theoretical framework. Clinicians identified four key considerations: (1) patients’ fragmented understanding arising from internet-sourced information; (2) optimisation of information delivery; (3) balancing information provision with patient readiness; and (4) communication and relational dynamics. In contrast, patients identified four key features of effective informed consent: (1) the clinician as a knowledge filter for online information; (2) the digital-era linguistic shift; (3) a spectrum of preferences for involvement in decision-making; and (4) the value of a cooling-off period. By integrating clinician and patient perspectives, this study provides contextual insights into contemporary orthodontic informed consent practices within a university-based clinical setting and proposes evidence-informed practical guidance to support patient-centred informed consent. The findings also highlight challenges and opportunities associated with the digital era, including the evolving role of clinicians in supporting patients’ navigation of online health information, adapting communication to individual decision-making preferences, and addressing broader ethical considerations in contemporary orthodontic practice.