eISSN 2097-6046
ISSN 2096-7446
CN 10-1655/R
Responsible Institution：China Association for Science and Technology
Sponsor：Chinese Nursing Association
中华急危重症护理杂志

Chinese Journal of Emergency and Critical Care Nursing >

2026 , Vol. 7 >Issue 2: 155 - 161

DOI: https://doi.org/10.3761/j.issn.2096-7446.2026.02.004

Special Planning: Improving Nursing Care Quality for ICU

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

  • XIA Lianzi ,
  • YU Fei ,
  • FENG Bo ,
  • ZHOU Hui ,
  • JI Kangling ,
  • WANG Qing
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  • 1. Department of Intensive Care Unit， Nanjing Drum Tower Hospital Clinical College of Jiangsu University， Nanjing 210000， China
    2. Department of Intensive Care Unit， Nanjing Drum Tower Hospital Affiliated Hospital of Medical School， Nanjing 210000， China
    3. Department of Nursing， Yunnan Mental Hospital， Kunming 650224， China
    4. Nursing Department， Nanjing Drum Tower Hospital Affiliated Hospital of Medical School， Nanjing 210000， China

Received date: 2025-03-07

  Online published: 2026-02-02

Supported by

Nanjing Drum Tower Hospital Average Project(2023-H516)

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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

Cite this article

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 . DOI: 10.3761/j.issn.2096-7446.2026.02.004

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