2025/10/11 by Jiaqi Shi, Jiajia Dai, Jia Bao Pan +4 · 1 voice
Health Professions · Engineering · Medicine · #Family and Patient Care in Intensive Care Units #Mechanical Circulatory Support Devices #Intensive Care Unit Cognitive Disorders
paper · doi:10.1111/nicc.70204
openalex publication_date 2025/10/11 · openalex created_date 2025/10/11 · openalex updated_date 2026/07/16
BACKGROUND: Family members making decisions about ECMO initiation face high-stakes uncertainty, emotional stress and cultural-ethical dilemmas. However, existing research lacks a synthesised understanding of these decision-making experiences across contexts. AIMS: To synthesise qualitative evidence on the experiences of family decision-makers during the pre-ECMO phase and develop a context-sensitive theoretical framework. STUDY DESIGN: A meta-synthesis was conducted following PRISMA 2020 guidelines. Six qualitative studies from 2011 to 2025 were included, spanning diverse cultural settings. Thematic synthesis and Gioia-informed coding were used to extract core patterns and reconstruct decision-making pathways. RESULTS: Five overarching themes emerged: (1) clinical decision urgency, (2) cognitive overload, (3) cultural and financial tensions, (4) intra-family dynamics and (5) the dual role of clinical communication. Families often experienced informational imbalance and emotional distress, intensified by cultural obligations and systemic constraints. CONCLUSIONS: We propose the ECMO Family Decision-Making Ecological Model, which emphasises the interactive influence of information processing, cultural values and institutional systems. The model offers a foundation for developing culturally tailored, human-centred decision support strategies in critical care. RELEVANCE TO CLINICAL PRACTICE: The central role of families in ECMO decision-making was emphasised, and a context-sensitive model was proposed to support clinicians in delivering more humanised, culturally informed critical care. TRIAL REGISTRATION: This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD420250652437.