# The effect of shared decision-making for critically ill patients: a systematic review and meta-analysis

## TL;DR

Shared decision-making in critical care does not reduce mortality or hospital stays but may shorten ICU stays for patients who die.

## Contribution

This study provides the first meta-analysis on shared decision-making in critical care, revealing specific effects on ICU length of stay for deceased patients.

## Key findings

- Shared decision-making did not significantly affect mortality or overall ICU/hospital length of stay.
- It reduced ICU length of stay for deceased patients but had no impact on mental health outcomes for surrogates.
- Decision-making and communication quality remained unchanged with shared decision-making interventions.

## Abstract

This systematic review and meta-analysis assessed the impact of shared decision-making on critically ill patients, focusing on outcomes such as mortality, intensive care unit (ICU) and hospital length of stay (LOS), and mental health symptoms in patients and their surrogates.

Following PRISMA guidelines, we searched PubMed, EMBASE, Web of Science, and Cochrane databases through March 2025 for randomized controlled trials (RCTs) assessing shared decision-making interventions in critically ill patients or surrogates. Risk of bias was assessed using the Cochrane tool, and data synthesis employed fixed or random-effects models based on heterogeneity.

Fifteen RCTs (2003–2025) involving 3,678 ICU patients and 2,777 surrogates were analyzed. Shared decision-making showed no significant association with all-cause mortality [risk ratio (RR) 1.05, 95% CI = 0.97–1.15]. Data analysis shows that the ICU LOS for deceased patients have shortened [standardized mean difference (SMD) = −0.15, 95% CI = −0.27 to −0.02, p = 0.02], but no effect on overall ICU LOS (SMD = 0.02, 95% CI = −0.06 to 0.10, p = 0.64) or hospital LOS (SMD = 0.02, 95% CI = −0.06 to 0.10, p = 0.64). Shared decision-making demonstrated no benefits for surrogate mental health outcomes, including depression (SMD = −0.04, 95% CI = −0.18 to 0.10, p = 0.57), anxiety (SMD = 0.06, 95% CI = −0.22 to 0.34, p = 0.69), or PTSD symptoms (SMD = −0.08, 95% CI = −0.37 to 0.21, p = 0.57). Decision-making quality (SMD = 0.02, 95% CI = −0.15 to 0.19, p = 0.81) and communication quality (SMD = 0.09, 95% CI = −0.09 to 0.27, p = 0.33) remained unchanged.

Shared decision-making may reduce ICU LOS for critically ill patients who ultimately die, without influencing mortality or overall hospitalization duration. Culturally tailored shared decision-making interventions are needed to address the heterogeneous needs of patients and surrogates across diverse populations.