Current status and influencing factors of decision conflict among surrogate decision-makers for patients with severe traumatic brain injury in the ICU.

OBJECTIVE: To investigate the current status of decision conflict among surrogate decision-makers for patients with severe traumatic brain injury in the intensive care unit (ICU) and to analyze its influencing factors. METHODS: From January to June 2025, a convenience sampling method was used to select 148 surrogate decision-makers of patients with severe traumatic brain injury admitted to a tertiary A-level hospital in Henan Province as the study participants. Data were collected using a general information questionnaire, the Decision Conflict Scale, the Decision Preparedness Scale, and the Shared Decision-Making Questionnaire. RESULTS: The Decision Conflict Scale score among surrogate decision-makers of ICU patients with severe traumatic brain injury was 43.36 ± 10.23. Overall, 92.6% of surrogate decision-makers experienced decision conflict, with 61.5% reporting high levels of decision conflict. Decision conflict levels were negatively correlated with decision preparedness and participation in shared decision-making (r = -0.403, -0.381; P < 0.05). Multiple linear regression analysis showed that family per capita monthly income, decision preparedness, and level of participation in shared decision-making were influencing factors of decision conflict among surrogate decision-makers. CONCLUSION: Surrogate decision-makers for ICU patients with severe traumatic brain injury experience moderate to high levels of decision conflict. Lower family per capita monthly income, lower decision preparedness, and lower participation in shared decision-making among surrogate decision-makers are associated with higher levels of decision conflict. Enhancing decision preparedness and promoting the implementation of shared decision-making can help reduce decision conflict among surrogate decision-makers.