How Culture and Structure Shape Shared Decision-Making Among Healthcare Professionals: "Practicing Tai Chi" in Neurocritical Stroke Care in China

Background Shared decision-making (SDM) is widely recommended in neurocritical stroke care due to prognostic uncertainty and the high-stakes nature of treatment decisions. However, SDM is shaped by sociocultural and healthcare system contexts, and evidence from non-Western settings remains limited. This study explored how and why contextual mechanisms influence SDM experiences and practices in Chinese neurocritical stroke care. Methods Underpinned by critical realism (CR), this interpretive qualitative study was conducted at a major tertiary medical center in central China. Semi-structured interviews were undertaken with 18 healthcare professionals (HCPs) involved in neurocritical stroke care. Data were analyzed using Fryer’s CR-informed thematic analysis to identify event-level patterns and infer underlying generative mechanisms. Results The analysis produced a multi-level conceptual model comprising a core experiential metaphor, seven descriptive event-level codes, and two interrelated mechanisms. The core experiential metaphor—“Practicing Tai Chi”—captured HCPs’ adaptive and strategically calibrated communication during SDM encounters, aimed at maintaining dialogue while reducing conflict and professional risk. SDM was typically family-led, with limited patient involvement, and was further shaped by relational and material constraints, including family dynamics, perceived trust, and financial pressures. These patterns were interpreted as arising from two intertwined mechanisms: familialism, which legitimizes family-centered decision norms, and a market-embedded healthcare system, which amplifies economic pressures and reinforces tension and mistrust between clinicians and families. Conclusions SDM in Chinese neurocritical stroke care is shaped by the interaction of cultural values and structural conditions. By identifying the mechanisms underpinning SDM practices, this study contributes a culturally grounded and theoretically robust perspective to the global SDM literature and highlights the need for context-sensitive approaches to SDM in neurocritical care.