ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究

doi:10.3761/j.issn.2096-7446.2026.02.004

Abstract

Abstract:

Objective To explore the barriers to participation in advance care planning（ACP） decision-making among surrogate decision-makers in the ICU，and to provide a basis for developing decision support tools. Methods From October 2024 to December 2024，an interview guide was developed based on the Theoretical Domains Framework（TDF）. Face-to-face interviews were conducted with 18 surrogate decision-makers of ICU patients in a tertiary hospital in Nanjing. The transcribed texts were analyzed according to the relevant domains of the TDF. Results Based on the TDF，the barriers to ACP decision-making among ICU surrogate decision-makers were categorized into 5 themes and 13 sub-themes： ①Execution barriers under ambiguous patient preferences； ②Breakdown in the procedural mechanisms of ACP participation；③Constraints from sociocultural norms and public discourse； ④Blurred role recognition of the decision-making surrogate； ⑤Irrational decision-making driven by emotions. Conclusion The ACP decision-making of ICU surrogate decision-makers is influenced by multiple factors. Cognitive restructuring，improved communication，emotional support，and reconstruction of the medical-social network are needed to reduce negative experiences during the decision-making process.

Key words: Advance Care Planning, Intensive Care Unit, Surrogate Decision Maker, Qualitative Study, Nursing Care

XIA Lianzi, YU Fei, FENG Bo, ZHOU Hui, JI Kangling, WANG Qing. A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 155-161.

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A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers

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