Anest. intenziv. Med. 2026;37(3):172-177 | DOI: 10.36290/aim.2026.034

Shared decision making in intensive careReview Article

Zvara M. ORCID...^1-2, Rusinová K. ORCID...²

¹ Klinika anesteziologie a resuscitace, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha

² Klinika paliativní medicíny, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha

Shared decision making in intensive care connects medically indicated treatment options with the patient's values, goals, and preferences. It is particularly important when patients lack decision-making capacity and their preferences have not been documented in advance. In such situations, decision making proceeds through patient surrogates and includes goals-of-care discussions, assessment of the appropriateness of life-sustaining treatment, and repeated review of the treatment plan as the clinical condition and prognosis evolve. High-quality shared decision making requires reliable prognostic assessment, verification of understanding, systematic elicitation and documentation of patient values, and structured communication with those close to the patient. Communication frameworks such as REMAP, VALUE, Best Case/Worst Case, and time-limited trials can help translate prognostic information and patient values into a concrete clinical recommendation. Out-of-hospital cardiac arrest represents one clinical situation in which these principles are especially important because of its sudden onset, the evolving nature of prognostic certainty, and the frequent absence of known patient preferences. This review summarizes the main principles of shared and surrogate decision making in intensive care and presents practical approaches that may support value-informed and clinically appropriate decisions.

Keywords: shared decision making, goals of care, surrogate decision­‑making, communication, prognostic awareness, family conference, out­‑of­‑hospital cardiac arrest.

Received: April 11, 2026; Revised: September 12, 2026; Accepted: September 14, 2026; Published: October 14, 2026  Show citation