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Factors Associated With Decision-Making Self-Efficacy Among Family Members of ICU Patients: A Cross-Sectional Study.

Yangfan Hu,Kun Li,Xuelan Peng,Yali Jiang,Wenxia Wang,Xixi Wang,Mingzhu Xin,Zhicheng Du,Juanjuan Zhao

Published 2025 in Journal of Advanced Nursing

ABSTRACT

AIMS To describe the level of family decision-making self-efficacy and its associated factors among Chinese family members of ICU patients. DESIGN Cross-sectional descriptive quantitative study. METHODS Using convenience sampling, 154 ICU patients and their family members from two tertiary hospitals completed a paper-based questionnaire assessing sociodemographic characteristics of patients and their family members, patients' disclosure of preferences to their family members, and family members' decision-making self-efficacy, anxiety and depression, uncertainty of illness, coping and social support. The data were analysed using independent-samples t-tests, one-way analysis of variance, Pearson correlation and multiple linear regression. RESULTS The average scores of self-efficacy in treatment, comfort promotion and facing death decision-making were 4.3 (SD = 0.6; range = 1-5), 4.2 (SD = 0.6; range = 1-5) and 3.5 (SD = 0.6; range = 1-5), respectively. Active coping was a predictor of self-efficacy in treatment, comfort-promoting and facing death decision-making. Patients' disclosure of preferences regarding mechanical ventilation, family members' anxiety and illness uncertainty were predictors of self-efficacy in treatment decision-making. Patients' disclosure of preferences regarding expensive medications was a predictor of self-efficacy in comfort-promoting decision-making, and patients' age was a predictor of self-efficacy in facing death decision-making. CONCLUSIONS Chinese family members of ICU patients reported relatively high self-efficacy in treatment and comfort promotion decision-making but lower self-efficacy in facing death decision-making. Active coping plays a critical role in enhancing decision-making self-efficacy across these three types of decisions. The predictors of decision-making self-efficacy varied according to the specific type of decision. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE For Chinese family members of ICU patients, targeted strategies to strengthen their active coping skills are key to enhancing their confidence in making decisions with or for patients. Patients' disclosure of preferences to their family members is helpful for improving family members' confidence in making treatment and comfort promotion decisions. Extra support is especially needed for end-of-life decision-making, particularly when the patient is younger. IMPACT This research informs future interventions by highlighting active coping and patients' disclosure of preferences to family members as key factors to strengthen decision-making self-efficacy among Chinese family members of ICU patients. However, family members' decision-making self-efficacy appears to be culturally specific, underscoring the need to design family-centered critical care approaches that are tailored to cultural contexts in other settings. Besides, while our research found a positive association between anxiety and self-efficacy in treatment decision-making, the relationship between them requires further investigation. REPORTING METHOD STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.

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