Objective To determine the levels and influencing factors of decision fatigue, decisional conflict, and shared decision-making among surrogate decision-makers of ICU patients, and to provide a reference for developing shared decision-making plans that better meet the needs of patients. Methods A total of 192 surrogate decision-makers of ICU patients were selected using a convenience sampling method and were invited to complete a general information questionnaire, the Decision Fatigue Scale, the Decisional Conflict Scale, and the Shared Decision Making Questionnaire (SDM-Q-9）. Results The participants scored (22.15±6.17) for decision fatigue, (41.55±14.00) for decisional conflict, and (78.47±12.86) for shared decision-making. Decisional conflict was negatively correlated with shared decision-making (P<0.05). Monthly income, whether living with the patient, and APACHEⅡ score of the patient were the influencing factors of decision fatigue for surrogate decision makers, while APACHEⅡ score was the influencing factor of decisional conflict, and medical payment type was the influencing factor of shared decision-making (all P<0.05). Conclusion The levels of decision fatigue and decisional conflict are relatively high in surrogate decision makers of ICU patients, while the level of shared decision-making is medium. Medical staff should pay attention to the factors affecting decision fatigue and decisional conflict in surrogate decision makers, and encourage them to participate in shared decision-making, thus to ameliorate their decision fatigue and decisional conflict.