ArticleBMJ open2026
Experiences of conflicting decision-making by surrogate decision-makers in neurocritical care in China: a descriptive qualitative study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to explore the experience of decision conflict among surrogate decision-makers for patients with critical illness undergoing neurosurgery.
designA qualitative descriptive research design was used. Participants were selected using a purposive sampling method, and semi-structured interviews were conducted to collect data, which were then analysed using Colaizzi's seven-step analysis method.
settingThe study was conducted in a tertiary hospital in China.
participantsThis study included 15 surrogate decision-makers for patients with critical illness undergoing neurosurgery as interview participants.
resultsIn this interview study, two main themes and nine subthemes were identified：(a) core conflict in the decision-making process: conflicts between the quality of life and the length of life, conflict between patient and surrogate preferences and conflict between the expected and realistic treatment outcomes; and (b) complex causes of decisional conflict: the burden of decision-making in critical care, inadequate decision-making information, erosion of patient-physician trust, socio-cultural pressures, overwhelming financial burden and negative emotional distress.
conclusionsSurrogate decision-makers for patients with neurological critical illness often experience complex decision conflicts during the clinical decision-making process. This underscores the need for healthcare providers to identify high-risk individuals for decision conflicts early on and provide personalised decision support strategies to mitigate such conflicts and enhance decision quality.
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