<![CDATA[Family involvement in shared decision-making (SDM) is an essential aspect of care in intensive care units (ICUs), particularly when critically ill patients are unable to participate directly in treatment decisions. This study aimed to map the evidence on family involvement in SDM, including participation patterns, decision-making approaches, influencing factors, and outcomes for patients and families. A scoping review was conducted using Arksey and O'Malley's framework and the PRISMA-ScR reporting guidelines. Three researchers searched ScienceDirect, Wiley Online Library, SpringerLink, and ProQuest in August 2025. Eligible studies were original research articles published in English between 2020 and 2025. Of the 3,850 records identified, 14 studies were included in the review. Four main themes emerged: family involvement throughout the care trajectory, decision-making approaches, facilitators and barriers, and reported outcomes. Family participation was most frequently observed during treatment-related decisions. Common approaches included family meetings, counseling, and structured SDM models. Effective communication, healthcare professionals' competence, and access to information were identified as key facilitators, whereas time constraints, emotional distress, and inadequate communication were major barriers. Reported family-related outcomes included greater satisfaction, improved understanding of prognosis, and better communication. However, psychological distress and decision regret were also reported. Patient-related outcomes were less frequently examined, although one intervention study reported a shorter hospital stay. Family involvement in SDM may promote collaborative and patient-centered critical care. Structured communication and culturally sensitive approaches are therefore needed, alongside further research examining patient outcomes and the long-term well-being of family members.]]>
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