Decisional conflict among Chinese family caregivers prior to ECMO initiation: a cross-sectional study.

The initiation of extracorporeal membrane oxygenation (ECMO) therapy for critically ill patients often requires complex and high-stakes decision-making by family members, who are frequently unprepared for such situations. This study aimed to determine the prevalence of decisional conflict among Chinese family caregivers prior to ECMO initiation and to examine associated biopsychosocial factors. A convenience sample of 169 family members of patients for whom ECMO initiation was deemed necessary by the treating team was recruited from a tertiary hospital in Jiangxi Province, China. Data were collected using validated instruments, including the Decisional Conflict Scale, Decision Preparedness Scale, Decision Fatigue Scale, Social Support Scale, and Wake Forest Physician Trust Scale. Univariate and multivariate logistic regression analyses were used to identify factors associated with decisional conflict. Decisional conflict was reported by 63.3% of participants. In univariate analyses, conflict was associated with family income, understanding of the patient’s condition and ECMO, decision fatigue, decision preparedness, physician trust, and social support (all P < 0.05). In multivariate analyses, higher decision fatigue was associated with greater decisional conflict (OR = 1.44, 95% CI 1.00–2.06). Lower understanding of ECMO (OR = 0.18, 95% CI 0.06–0.58), lower physician trust scores (indicating higher trust; OR = 3.15, 95% CI 1.51–6.57), and lower social support (OR = 0.443, 95% CI 0.280–0.70) were significantly associated with increased decisional conflict. A substantial proportion of Chinese family caregivers of ECMO patients experience decisional conflict prior to treatment initiation. Clinical practice must uphold the ethical obligation of providing complete and comprehensible information to patients or surrogates. Beyond this baseline, structured communication strategies (e.g., family meetings, standardized ECMO information sheets) and decision-support tools may help families understand patients’ presumed wishes and reduce decisional conflict under time-pressured ICU conditions. Where feasible, interventions to alleviate decision fatigue, strengthen physician–family trust, and reinforce available social support resources may further support surrogate decision-making. Clinical trial number Not applicable.