Objective To investigate the current situation of decision-making conflicts among surrogate decision-makers for ICU patient and analyze its influencing factors. Methods A total of 390 surrogate decision-makers for ICU patient were chosen as the research participants by using the convenience sampling method. The survey was conducted with the general information questionnaire, the Decision Conflict Scale (DCS), the Preparation for Decision Making Scale (Prep-DMS), the Decisional Engagement Scale (DES-10), and the Wake Forest Physician Trust Scale (WFPTS). Results The decision conflict score of the surrogate decision-makers was (43.33±7.25), decision preparation score was (30.62±6.81), decision participation score was (64.46±10.37), and physician trust score was (37.95±6.35). Pearson correlation analysis showed that the total decision conflict score of the surrogate decision-makers and the total score of decision preparation, decision participation, and of physician trust were negatively correlated (all P<0.05). Multiple linear regression analysis showed that knowledge of the disease, age of the surrogate decision-maker, decision participation, decision preparation, and physician trust were the main influencing factors of surrogate decision-makers′ decision conflict scores (all P<0.05), explaining 43.1% of the total variation. Conclusion Decision conflict among surrogate decision-makers for ICU patients is at a high level. It is recommended that nursing managers should intervene with the surrogate decision-makers who have higher levels of decisional conflict to alleviate their decision-making dilemma, improve the quality of decision-making, and maximize patient benefits.