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Background <p>Shared decision-making (SDM) is widely recommended for critically ill patients with stroke receiving neurocritical care owing 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 examined how contextual factors influence SDM practices in the care of critically ill patients with stroke in China.</p> Methods <p>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 caring for critically ill patients with stroke. Data were analyzed using Fryer’s CR approach to thematic analysis to identify patterns in decision-making practices and develop explanatory interpretations of underlying contextual mechanisms.</p> Results <p>Participants described decision-making discussions with families as dynamic and strategically navigated interactions. One participant likened this communication approach to “practicing Tai Chi,” reflecting clinicians’ efforts to adapt communication and manage responsibility during high-stakes decisions. The analysis identified seven recurring decision-making patterns, including family dominance, limited patient involvement, the influence of family relationships, and the central role of financial considerations. Two broader contextual mechanisms were identified: a cultural mechanism emphasizing family authority in medical decisions, and structural influences associated with a market-embedded healthcare system that shape trust, accountability concerns, and financial constraints.</p> Conclusions <p>In this setting, SDM practices were strongly shaped by sociocultural and structural conditions, resulting in decision-making processes characterized by family-led decisions, limited patient participation, and cautious clinician engagement. These findings prompt reflection on the culturally contingent nature of SDM processes that take different forms across healthcare contexts. This underscores the importance of developing context-sensitive approaches to SDM in neurocritical care.</p>

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Cultural and Structural Influences on Shared Decision-Making in the Care of Critically Ill Patients with Stroke in China: A Critical Realist Qualitative Study

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  • 发表日期：

    2026年6月15日

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  • Hui Zhang,
  • Carmel Davies,
  • Chunhai Su,
  • Deirdre O’Donnell

摘要

Background

Shared decision-making (SDM) is widely recommended for critically ill patients with stroke receiving neurocritical care owing 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 examined how contextual factors influence SDM practices in the care of critically ill patients with stroke in China.

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 caring for critically ill patients with stroke. Data were analyzed using Fryer’s CR approach to thematic analysis to identify patterns in decision-making practices and develop explanatory interpretations of underlying contextual mechanisms.

Results

Participants described decision-making discussions with families as dynamic and strategically navigated interactions. One participant likened this communication approach to “practicing Tai Chi,” reflecting clinicians’ efforts to adapt communication and manage responsibility during high-stakes decisions. The analysis identified seven recurring decision-making patterns, including family dominance, limited patient involvement, the influence of family relationships, and the central role of financial considerations. Two broader contextual mechanisms were identified: a cultural mechanism emphasizing family authority in medical decisions, and structural influences associated with a market-embedded healthcare system that shape trust, accountability concerns, and financial constraints.

Conclusions

In this setting, SDM practices were strongly shaped by sociocultural and structural conditions, resulting in decision-making processes characterized by family-led decisions, limited patient participation, and cautious clinician engagement. These findings prompt reflection on the culturally contingent nature of SDM processes that take different forms across healthcare contexts. This underscores the importance of developing context-sensitive approaches to SDM in neurocritical care.