Patient involvement in surgical decision-making is increasingly recognized as a cornerstone of patient-centered care, yet evidence from low- and middle-income countries (LMICs) remains limited. Understanding healthcare providers’ perceptions of patient participation, satisfaction, and the role of technology in these settings is essential to inform practice and policy.

A Delphi survey was conducted on The Operating Room Global (TORG) platform with 184 healthcare professionals, including surgeons, nurses, anesthesiologists and allied staff from 12 LMICs. The survey explored frequency, challenges and determinants of patient involvement in surgical decision-making, as well as satisfaction levels and technology utilization. Quantitative data were analyzed using descriptive statistics, while qualitative responses underwent narrative analysis.

Most respondents reported frequent patient involvement in surgical decision-making (34.6% often; 31.4% very often). Important influencing factors included physician recommendations (59.1%), treatment options (61.0%), and patients’ medical history (54.6%). Major barriers included lack of patient education materials (63.0%), time constraints (57.1%), language barriers (50.7%), and cultural differences (50.7%).

Preoperative counseling was the predominant method used to assess patient understanding (86.4%), whereas decision aids were underutilized (36.6%). Patient satisfaction was generally positive, with 67.9% reporting satisfied or very satisfied experiences, although 30.6% reported neutral or negative experiences. Online resources (45.1%) and telemedicine (16.4%) emerged as technology facilitators of patient engagement.

Patient involvement in surgical decision-making is valued but inconsistently practiced across LMICs. Addressing language and cultural gaps, expanding educational resources, and integrating decision aids and digital health tools may enhance patient-centered surgical care and patient satisfaction.