Decisional Conflict Among Chinese Family Caregivers Prior to ECMO Initiation: A Cross-Sectional Study in Critical Care Nursing

Background The initiation of extracorporeal membrane oxygenation (ECMO) therapy for critically ill patients often necessitates complex, high-stakes decision-making by family members, who typically have limited preparation. This study aimed to quantify the prevalence of decisional conflict among Chinese family caregivers of patients prior to ECMO initiation and to identify modifiable biopsychosocial factors contributing to this conflict. Methods A convenience sample of 169 family members of patients undergoing ECMO treatment was recruited from a tertiary hospital in Jiangxi Province, China. Data were collected using validated instruments: 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 performed to identify factors associated with decisional conflict. Results The incidence of decisional conflict among family members was 63.3%. Univariate analysis revealed significant associations (P < 0.05) between decisional conflict and family monthly income, understanding of the patient's condition and ECMO treatment, decision fatigue, decision preparedness, physician trust, and social support. Multivariate analysis identified decision fatigue as a significant risk factor (OR = 1.44, 95% CI: 1.00-2.06). Conversely, understanding of ECMO treatment (OR = 0.18, 95% CI: 0.06–0.58), physician trust (OR = 3.15, 95% CI: 1.51–5.57), and social support (OR = 0.85, 95% CI: 0.72–0.99) were identified as protective factors. Conclusions A substantial proportion of Chinese family caregivers of ECMO patients experience high levels of decisional conflict. Clinical interventions should prioritize enhancing information provision, mitigating decision fatigue, fostering physician trust, and strengthening social support systems to improve decision quality and ultimately optimize patient outcomes in this critical care setting. Clinical trial number Not applicable.