Shared Decision-Making With a Surrogate for Life-Sustaining Treatment of Critically Ill Patients: Protocol for a Scoping Review

Abstract
BackgroundShared decision-making (SDM) is a collaborative process that integrates patients’ values and preferences into health care decisions. In intensive care units, patients who are critically ill often lack the capacity to make decisions, necessitating surrogates to make complex choices regarding life-sustaining treatments (LSTs).
ObjectiveThis scoping review aims to assess the range of research conducted on surrogate SDM for LSTs among patients who are critically ill over the past decade and highlight areas where current research remains limited.
MethodsThis scoping review will follow the Joanna Briggs Institute methodology and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Studies will be included if they examine SDM involving surrogates of adult patients who are critically ill in relation to LST decisions within intensive care unit settings. SDM is defined using 4 criteria: participation of both health care professionals and surrogates, mutual information sharing, consensus building, and agreement on treatment based on the patient’s values and preferences. A comprehensive search will be performed across PubMed, CINAHL, PsycInfo, CENTRAL, and Ichushi-Web for English- and Japanese-language studies published between 2016 and 2025. Eligible study designs will include quantitative, qualitative, and mixed methods research. Title and abstract screening, as well as full-text selection, will be conducted independently by 2 reviewers using Rayyan. Data will be extracted on study characteristics, SDM definitions, participant roles, and key findings. Results will be synthesized descriptively and presented in tables and narrative summaries to identify research gaps and inform future investigations.
ResultsAs of June 13, 2025, the literature search has been completed. A total of 2899 citations were identified through the specified database searches, and 527 (18.2%) duplicates were removed. Title and abstract screening are currently in progress, and full-text review is expected to be completed by September 2025.
ConclusionsThis scoping review will systematically map recent evidence on surrogate SDM in the context of LST decisions for patients who are critically ill. By synthesizing diverse studies, it will identify challenges faced by surrogates and summarize existing interventions that aim to improve SDM processes. The findings are expected to inform future interventions and policies and advance patient- and family-centered care in critical care settings.