Nurses’ experiences with decision-making regarding life-sustaining treatment withdrawal in adult intensive care: A systematic review

Background: There is a need for a systematic review of nurses’ experiences with the decision-making process regarding withdrawing life-sustaining treatment from adult intensive-care patients, which involves nurse-doctor collaboration. Aim: To synthesise nurses’ experiences with the decision-making process regarding withdrawing life-sustaining treatment from adult intensive-care patients. Method: This qualitative systematic review employed Aveyard’s framework. A systematic search was performed in November 2024 in three databases, and an updated search was conducted in February 2026 in two of them. Study selection and data extraction were independently performed by author pairs. Thematic synthesis was conducted. Findings: Thirteen studies were included in the systematic review. Three analytical themes were synthesised: The nurse’s role in navigating complex situations, Asymmetric decision-making power and challenges in interdisciplinary collaboration and Ethical tensions and diverging needs challenging the decision-making process. Conclusion: Nurses’ participation in the decision-making process regarding withdrawing life-sustaining treatment is challenged by ethical and cultural aspects.