The surrogate decision-making experience of family members for patients with acute stroke: a qualitative meta-synthesis

AIMS: This study aims to integrate the experiences of surrogate decision-making by family members of patients with acute stroke and to understand their feelings and needs. METHODS AND RESULTS: A qualitative meta-synthesis was conducted to extract and analyse qualitative research from PubMed, Web of Science, Embase, Cochrane, CINAHL, and Chinese databases, including China National Knowledge Internet, Wanfang Database, Chinese Biomedical Literature Database (Sinomed), and VIP database from the inception of the database to 6 November 2025. This review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Systematic Reviews of Qualitative Evidence. Two reviewers independently performed study screening and data extraction processes. The quality of included studies was assessed using the JBI critical appraisal tool for qualitative research. For data analysis, the thematic synthesis approach proposed by Thomas and Harden was adopted. The nine included studies were synthesized into three themes and eight subthemes. The three themes were dilemmas and challenges of the surrogate decision-making process, core basis for family surrogate decision-making, and factors influencing family members' surrogate decision-making. CONCLUSION: Family members of acute stroke patients face multiple dilemmas and challenges in surrogate decision-making, necessitating scientific interventions to support decision-making. Healthcare providers should proactively strive to alleviate the decision-making burden on family members, ultimately safeguarding both the patient's optimal treatment outcomes and the family's physical and mental well-being. REGISTRATION: A protocol was registered on the PROSPERO (CRD420251182588).