biostudies-literatureUnknown13Wang Y<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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, <i>p</i> = 0.02], but no effect on overall ICU LOS (SMD = 0.02, 95% CI = -0.06 to 0.10, <i>p</i> = 0.64) or hospital LOS (SMD = 0.02, 95% CI = -0.06 to 0.10, <i>p</i> = 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, <i>p</i> = 0.57), anxiety (SMD = 0.06, 95% CI = -0.22 to 0.34, <i>p</i> = 0.69), or PTSD symptoms (SMD = -0.08, 95% CI = -0.37 to 0.21, <i>p</i> = 0.57). Decision-making quality (SMD = 0.02, 95% CI = -0.15 to 0.19, <i>p</i> = 0.81) and communication quality (SMD = 0.09, 95% CI = -0.09 to 0.27, <i>p</i> = 0.33) remained unchanged.<h4>Conclusion</h4>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.Frontiers in medicine1726976https://www.ebi.ac.uk/biostudies/studies/S-EPMC12901507biostudies-literatureThe effect of shared decision-making for critically ill patients: a systematic review and meta-analysis.PMC12901507Shen KHe SLi JZhang JYang MYin NWang YHuang BfalseThe effect of shared decision-making for critically ill patients: a systematic review and meta-analysis.<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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, <i>p</i> = 0.02], but no effect on overall ICU LOS (SMD = 0.02, 95% CI = -0.06 to 0.10, <i>p</i> = 0.64) or hospital LOS (SMD = 0.02, 95% CI = -0.06 to 0.10, <i>p</i> = 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, <i>p</i> = 0.57), anxiety (SMD = 0.06, 95% CI = -0.22 to 0.34, <i>p</i> = 0.69), or PTSD symptoms (SMD = -0.08, 95% CI = -0.37 to 0.21, <i>p</i> = 0.57). Decision-making quality (SMD = 0.02, 95% CI = -0.15 to 0.19, <i>p</i> = 0.81) and communication quality (SMD = 0.09, 95% CI = -0.09 to 0.27, <i>p</i> = 0.33) remained unchanged.<h4>Conclusion</h4>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.2026-01-01T00:00:00Z20262026-07-08T03:17:23.215Z2026-07-08T03:08:44.066ZS-EPMC129015074169515710.3389/fmed.2026.1726976