Background Caring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process. Objectives To explore family surrogate decision-making for people with chronic critical illness. Methods In this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis. Results Family surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as frustrating, most surrogates reported that they were comfortable with this role. Major decision-making themes were as key in decision-making, impact of past experiences, and difficulties and coping. Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges. Conclusions Results support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes.

Karen O. Moss

Sara L. Douglas

Eric Baum

Barbara Daly

Critical Care Nurse

重症监护护士 (CCN) 是美国重症监护护士协会 (AACN) 的官方出版物。邀请作者提交手稿以供考虑和同行评审。临床主题必须符合 CCN 的使命，并解决急危重症患者的护理实践。

Critical Care Nurse is the official publication of the American Association of Critical-Care Nurses (AACN). We invite authors to submit manuscripts for consideration and peer review. Clinical topics must align with the mission of Critical Care Nurse and address the nursing practice for critically ill patients.

《Critical Care Nurse》是美国重症监护护士协会（AACN）的官方出版物。我们欢迎作者提交手稿以供考虑和同行评审。临床主题必须符合《Critical Care Nurse》的使命，并关注急危重症患者的护理实践。

Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis

Data support recent recommendations of the National Academy of Medicine that endorsed shared decision-making for people with chronic critical illness and support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity.

Category	Quartile
医学	4
医学, 危重病医学	4
医学, 护理	4

Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis

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