Experiences of conflicting decision-making by Surrogate decision-makers in Neurocritical care in China: a descriptive qualitative study

Background: Decision-makers who act on behalf of patients in critical neurosurgical care play a crucial role in medical decision-making. However, there is limited exploration into the complexities of decision conflict within this group. Objectives: This study aims to understand the experiences of decision-making conflict among surrogate decision-makers for neurosurgical critical care patients, with the goal of informing the development of clinical decision support programs. Methods: Between April 2023 and June 2023, we conducted semi-structured, in-depth interviews with 15 surrogate decision-makers for neurosurgical critical care patients, using a convenience sampling method. The interviews were meticulously transcribed, and the data underwent detailed analysis using the Colaizzi 7-step method to extract and refine thematic insights. Results: The study reveals that surrogate decision-makers for critically ill neurosurgical patients grapple with decision conflict across three main themes: (a) Various Aspects of Decision-Making Conflict: Conflicts arise between considerations of quality versus length of life, patient preferences versus those of the decision-maker, and expectations of treatment versus reality. (b) Complex Causes of Decision-Making Conflict: Challenges include the complexity of decision-making in critical care settings, limited access to information, and societal and cultural pressures. (c) Diverse Consequences of Decision-Making Conflict: These include emotional distress for decision-makers, delays in patient treatment, and risks to patient-physician trust. Conclusions: The research findings highlight that surrogate decision-makers for critically ill neurosurgical patients encounter a range of complex conflicts with various negative impacts in clinical settings. These insights emphasize the importance of medical professionals identifying surrogate decision-makers prone to conflict early in the care journey and offering evidence-based decision-making support to minimize conflicts and improve decision-making quality.