Perspectives and experiences of ICU healthcare professionals on conscious ICU patients' involvement in shared decision-making: a qualitative study.

Abstract

To explore intensive care unit (ICU) healthcare professionals' perceptions and experiences of shared decision-making with conscious patients. A qualitative descriptive study using semistructured interviews. Three ICUs at a Joint Commission International-accredited hospital in Hangzhou, Zhejiang Province, China. 16 ICU healthcare professionals (9 females, 7 males; aged 23-45 years) were interviewed between September and November 2024. We identified 10 subthemes that were classified into three themes: (a) conscious but not ready: unstable decision-making ability, insufficient emotional readiness and limited cognitive evaluability; (b) the roles of doctors and nurses in shared decision-making (SDM): physicians as advisors, not decision-makers, nurses' limited role in SDM and fragmented team communication hinders information flow and (c) the double-edged sword of patient participation: protection or blame, collaboration or burden, hope or harm and being caught between values. ICU healthcare professionals acknowledge the value of involving conscious patients in SDM but also recognise its complexity. Challenges include assessing patients' fluctuating decision-making capacity, poor team communication and the potential for both benefit and harm. These findings highlight the need for clearer professional roles and more structured support.