Conversations Between Family Members and Physicians in Intensive Care Unit During Shared Decision-Making: A Qualitative Observational Study

It is necessary to understand the decision-making dynamics between physicians and families so as to help families better participate in shared decision-making. A qualitative observational research was conducted. Conversations between physicians and families at a tertiary care hospital from July to December 2022 were audio-recorded. The families were those with critically ill patients lacking decision-making capacity in the intensive care unit. Data were analyzed using an inductive content analysis method. A total of 40 conversations were analyzed. There were 12, 15, and 13 decisions made on the day of hospital admission, when the patient's condition changed, and during the end-of-life situation, respectively. In all decision-making stages, some sharing of information occurred between physicians and families. The degree of sharing differed depending on the decision-making context. In end-of-life situations, decision-making mostly involved families, which might only represent the values and preferences from family members but not patients. Evidence of shared decision-making between physicians and family members was low. The levels of shared decision-making varied according to the context in which decisions were made. The shared decision-making between physicians and families might only represent the values and preferences from family members but not patients. Family members often faced decision-making difficulties and regrets.