Decisional Conflict and Its Influencing Factors Among Surrogate Decision Makers for Endovascular Therapy in Acute Ischemic Stroke Patients: A Cross-Sectional Study

Decisional conflict among surrogate decision-makers for acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT) is a critical concern because delayed treatment decisions may compromise reperfusion timing and patient outcomes. In China, written informed consent is required before EVT, while many AIS patients are unable to decide independently because of cognitive or language impairment. Thus, family surrogates often make urgent, high-stakes decisions under emotional, informational, and financial pressure. This cross-sectional study examined the level of decisional conflict and its influencing factors among AIS-EVT surrogate decision-makers and developed a conceptual model. A descriptive correlational design with multiple regression analysis was used. Through simple random sampling, 150 surrogate decision-makers were recruited from a National Advanced Stroke Center in Henan Province, China, from January to May 2026. Data were collected using the Chinese Decisional Conflict Scale and a general information questionnaire. Results showed a medium decisional conflict level (35.42±12.18), with 33.3% experiencing high conflict. Decision support and effectiveness recorded the highest dimension score. Education, income, occupation, relationship to the patient, financial burden, stroke knowledge, and NIHSS score significantly predicted conflict. Decisional conflict was positively correlated with decision-making time. Findings support targeted decision aids, financial counseling, communication training, and public stroke education.